Medicare Part B covers refraction as part of a comprehensive eye exam, but only when performed by an ophthalmologist or optometrist during a medically necessary visit.
Refraction is the test that determines your eyeglass or contact lens prescription — the one where the doctor asks "which is better, one or two?" Medicare Part B pays for this test when it is bundled into a full eye exam ordered for a medical reason, such as checking for glaucoma, cataracts, or managing diabetes-related eye changes. The exam itself must be medically necessary, not a routine vision check for new glasses.
The distinction matters. If you go to the eye doctor solely to update your prescription for reading glasses or contacts, Medicare does not cover that visit or the refraction. If you go because your ophthalmologist wants to monitor your diabetic retinopathy or screen for age-related macular degeneration, and refraction happens as part of that exam, Medicare covers the refraction as part of the overall service.
Key Takeaways
- Medicare Part B covers refraction only when it is part of a medically necessary eye exam ordered by your doctor.
- Routine vision exams for new glasses or contacts are not covered, even if refraction is performed.
- You pay 20 percent of the Medicare-approved amount for the exam after you meet your Part B deductible.
- Eyeglasses and contact lenses themselves are never covered by Original Medicare, regardless of the reason for the exam.
- Medicare Advantage plans may offer additional vision coverage, so check your plan documents.
When Medicare covers the eye exam that includes refraction
Your doctor orders an eye exam for a medical reason — not to get new glasses, but to diagnose or monitor an eye disease or condition. Common reasons include screening for glaucoma, evaluating cataracts, monitoring diabetic retinopathy, checking for age-related macular degeneration, or assessing vision changes after an eye injury or surgery. During that exam, the eye doctor performs refraction to measure your current prescription.
Because the visit itself is medically necessary, Medicare covers the entire exam, including the refraction. You will owe 20 percent of the Medicare-approved amount after you have met your Part B deductible for the year. If you see an out-of-network provider who does not accept Medicare assignment, you may owe more.
When Medicare does not cover refraction
If your only reason for the visit is to get a new prescription for glasses or contacts, Medicare does not cover the exam or the refraction. This is considered a routine vision service, not a medical service. Many people schedule these visits annually or when their vision changes, and Medicare treats them the same way it treats routine dental cleanings or haircuts — as personal care rather than medical care.
The same rule applies even if you have a vision problem. If you have presbyopia (age-related difficulty focusing on close objects) or myopia (nearsightedness) and want glasses to correct it, the exam and refraction are not covered. Medicare covers only exams ordered to diagnose or manage a disease or condition of the eye.
What you pay for a covered eye exam
When Medicare covers the exam, you pay 20 percent of the Medicare-approved amount after you meet your Part B deductible. The deductible for Part B in 2024 is $240, though this amount changes yearly. Once you have paid $240 out of pocket for Part B services in that calendar year, you owe 20 percent of approved charges for the rest of the year.
The actual cost depends on what the eye doctor charges and whether they accept Medicare assignment. If your ophthalmologist or optometrist accepts assignment, they agree to accept Medicare's approved amount as full payment (except for your 20 percent share). If they do not accept assignment, they can charge up to 15 percent more than the approved amount, and you may owe that difference in full.
Eyeglasses and contact lenses are never covered
Even when Medicare covers the eye exam and refraction, it does not cover the cost of eyeglasses, contact lenses, or the fitting of contacts. You pay the full cost of frames, lenses, and any lens treatments (such as anti-reflective coating) out of your own pocket. Some people use a vision discount plan or a separate vision insurance policy to reduce these costs.
If you are looking for lower-cost glasses, you can use your prescription at any optical retailer — you are not required to buy from the eye doctor's office. Many retailers offer frames and basic lenses at lower prices than medical offices do.
Medicare Advantage plans and vision coverage
Original Medicare (Part A and Part B) does not cover routine eye exams or refraction for glasses. However, many Medicare Advantage plans (Part C) include vision coverage as an added benefit. Some plans cover routine eye exams, refraction, and even a small allowance toward glasses or contacts each year.
If you have a Medicare Advantage plan, check your plan documents or call the plan's customer service line to learn what vision services are included. Coverage varies widely from plan to plan, and some plans cover routine exams while others do not. Your plan may also have a network of eye doctors you must use to receive the benefit.
How to know if your eye exam will be covered
Before you schedule an eye exam, call your eye doctor's office and tell them the reason your doctor referred you or why you are coming in. Explain the medical condition or concern — for example, "my primary care doctor wants me screened for glaucoma" or "I have diabetes and need my eyes checked for diabetic retinopathy." The office staff can tell you whether Medicare will cover the visit based on that reason.
You can also call Medicare directly at 1-800-MEDICARE to ask whether a specific type of eye exam is covered. Have the medical reason for the exam ready when you call. If you are unsure whether your reason qualifies, it is worth asking before the visit so you know what to expect to pay.
Frequently Asked Questions
Does Medicare cover an eye exam if I have no eye disease?
No. Medicare covers eye exams only when they are ordered to diagnose or monitor a disease or condition of the eye — such as glaucoma, cataracts, or diabetic retinopathy. If you have no eye disease and want an exam to update your glasses prescription, Medicare does not cover it.
If Medicare covers my eye exam, do I have to pay for the glasses?
Yes. Medicare covers the exam and refraction but never covers the cost of eyeglasses, contact lenses, or lens fittings. You pay the full cost of frames and lenses yourself, though you can use your prescription at any optical retailer.
What if my eye doctor does not accept Medicare?
If your eye doctor does not accept Medicare assignment, they can charge up to 15 percent more than Medicare's approved amount. You will owe that difference in addition to your 20 percent coinsurance. Ask the office whether they accept Medicare assignment before your visit.
Does my Medicare Advantage plan cover routine eye exams?
Many Medicare Advantage plans include vision coverage, but it varies by plan. Some cover routine exams and refraction; others do not. Check your plan documents or call your plan's customer service to learn what vision benefits you have and whether there are network restrictions.
Can I use my Medicare refraction at any glasses store?
Yes. Your prescription belongs to you, and you can use it at any optical retailer — the eye doctor's office, a chain retailer, an online glasses company, or an independent optician. You are not required to buy from the doctor who performed the refraction.