Medicare does not pay for contact lenses, but it may cover the eye exam that determines your prescription

Original Medicare (Parts A and B) does not cover the cost of contact lenses themselves. Medicare also does not cover eyeglasses or the fitting of either. However, Medicare Part B does cover one routine eye exam every 24 months if you have diabetes or a history of eye disease, and it covers one baseline eye exam if you are turning 65. If you need contact lenses, you will pay for them out of pocket, though you can use the prescription from a covered exam to purchase them from any retailer.

Some Medicare Advantage plans (Part C) include vision coverage that may pay toward contact lenses, eyeglasses, or both. The amount and type of coverage varies widely by plan and by year. If you are enrolled in a Medicare Advantage plan, check your plan documents or call the plan directly to learn what vision benefits you have.

Key Takeaways

  • Original Medicare does not pay for contact lenses, eyeglasses, or the fitting of either.
  • Medicare Part B covers one routine eye exam every 24 months if you have diabetes or eye disease, and one baseline exam at age 65.
  • You can use a prescription from a Medicare-covered exam to purchase contact lenses from any retailer and pay out of pocket.
  • Some Medicare Advantage plans include vision coverage that may help pay for contact lenses; you must check your specific plan.

What Original Medicare covers for your eyes

Original Medicare Part B covers an eye exam under specific circumstances. If you have diabetes, you are covered for one dilated eye exam every 12 months to screen for diabetic retinopathy. If you have a history of glaucoma or age-related macular degeneration, you are covered for one exam every 24 months. If you are turning 65 and have never had a baseline eye exam under Medicare, Part B covers one baseline exam in the year you turn 65.

These covered exams are performed by an ophthalmologist or optometrist who accepts Medicare. The exam itself is covered at no cost to you after you meet your Part B deductible. However, the coverage applies only to the exam — not to glasses, contact lenses, or the cost of fitting either one.

If you do not fall into one of these categories, Original Medicare does not pay for routine eye exams. You would pay the full cost out of pocket or through a vision insurance plan you purchase separately.

How Medicare Advantage plans handle vision coverage

Medicare Advantage plans are required to cover everything Original Medicare covers, but many also add extra benefits. Vision coverage is one of the most common add-ons. Some Medicare Advantage plans include a vision benefit that covers eye exams, contact lenses, eyeglasses, or some combination of these.

The specifics differ by plan. One plan might cover up to $150 per year toward contact lenses; another might cover the full cost of one pair of eyeglasses and nothing toward contacts. Some plans cover the eye exam but not the lenses themselves. Coverage amounts, frequency, and which providers you can use all depend on your individual plan.

To find out what your Medicare Advantage plan covers for vision, look at your plan's Summary of Benefits and Coverage document, which you received when you enrolled. You can also call the plan's customer service number (on the back of your insurance card) and ask specifically what they pay toward contact lenses, eyeglasses, and eye exams.

Where to buy contact lenses with your prescription

Once you have a prescription from an eye exam, you can purchase contact lenses from any retailer — online, at a pharmacy, or at an optical shop. You do not have to buy from the office where you had the exam. By law, the eye care provider must give you a copy of your prescription at the end of your exam, even if you do not ask for it.

Contact lens prices vary widely depending on the brand, the type (daily disposable, weekly, monthly), and where you buy them. Online retailers often have lower prices than brick-and-mortar stores, but shipping times and return policies differ. Some people find it helpful to compare prices across a few retailers before ordering.

If you have a Medicare Advantage plan that covers contact lenses, the plan will specify which retailers are in-network and how much you pay. Using an in-network retailer usually means a lower out-of-pocket cost for you.

Paying for eye exams if you do not may have access to for Medicare coverage

If you do not have diabetes, a history of eye disease, or are not turning 65, Original Medicare does not pay for a routine eye exam. In that case, you have several options.

You can pay out of pocket at an ophthalmologist's or optometrist's office. The cost typically ranges from $100 to $300 depending on the provider and your location, though this varies. Some community health centers and vision clinics offer exams on a sliding fee scale based on income. You can search for these through your local health department or by calling 211 (a free helpline that connects you to local services).

If you have a Medicare Advantage plan with vision coverage, that plan may pay for routine eye exams regardless of your health history. Again, check your plan documents or call the plan to confirm.

Using other vision insurance alongside Medicare

You can purchase a standalone vision insurance plan even if you have Original Medicare. These plans are separate from Medicare and typically cost $10 to $30 per month. They usually cover eye exams, contact lenses, eyeglasses, or all three, depending on the plan you choose.

If you are enrolled in a Medicare Advantage plan that already includes vision coverage, you generally do not need a separate vision plan — the coverage would overlap and you would be paying for benefits twice. However, if Original Medicare is your coverage and you want vision benefits, a standalone plan can be a cost-effective option if you need frequent eye exams or expensive contact lenses.

Vision plans are sold by insurance companies and through membership organizations like AARP. You can compare plans and costs online or by calling providers directly. Make sure the plan covers the type of vision care you need most — some plans emphasize eyeglasses, others emphasize contacts.

What happens if you lose or damage your contact lenses

If you lose or damage a contact lens, you will need to replace it. If you have a current prescription, you can order a replacement from any retailer. The cost depends on the brand and type of lens, but a single replacement lens typically costs $10 to $50.

If you damage your lens and cannot wear it while waiting for a replacement, you may need to wear eyeglasses temporarily. If you do not have a current glasses prescription, you can ask your eye care provider for one during your next exam. Medicare does not pay for eyeglasses, but a standalone vision plan or out-of-pocket payment can cover them.

Frequently Asked Questions

Can I use my Medicare prescription at any contact lens retailer?

Yes. Your eye care provider must give you a copy of your prescription, and you can use it at any retailer — online, at a pharmacy, or at an optical shop. You are not required to buy from the provider's office.

Does Medicare Advantage always include vision coverage?

No. While many Medicare Advantage plans include vision benefits, not all do. You must check your specific plan's documents or call the plan to find out whether vision coverage is included and what it covers.

What if I need an eye exam but do not have diabetes or eye disease?

Original Medicare does not cover routine eye exams in that case. You can pay out of pocket, look for a community health center with sliding-scale fees, or purchase a standalone vision insurance plan. Some Medicare Advantage plans cover routine exams regardless of health history.

Can I get a new contact lens prescription every year?

Contact lens prescriptions typically expire after one or two years, depending on your eye care provider's policy. You will need a new exam to get a new prescription. If you have diabetes or eye disease, Medicare covers one exam every 12 to 24 months. Otherwise, you pay out of pocket or use a vision plan.

Do I have to choose between eyeglasses and contact lenses for coverage?

It depends on your plan. Some Medicare Advantage vision plans cover both eyeglasses and contact lenses up to a certain dollar amount per year. Others cover one or the other. Check your plan documents to see whether you can use your vision benefit for both or must choose one.