Does Medicare Cover Eye Exams?

Original Medicare doesn’t cover routine vision care in most cases. There are exceptions and other options.

Original Medicare does not pay for routine eye examinations unless you are in a high risk group for eye disease. However, some Medicare Advantage plans include vision coverage.

Some eye conditions can be very serious and are not apparent in the early stages. Treatment could reduce or prevent loss of vision. It is important for all Medicare beneficiaries to have regular eye exams.

According to the National Eye Institute, most Americans should have an eye examination every year or so, and those in high-risk groups such as African Americans aged 40 and older and people with diabetes, high blood pressure or a family history glaucoma should also get one.

What is Medicare’s coverage for eye exams?

Medicare Part B (part of Original Medicare) covers an eye exam only when a patient has diabetes, which can cause diabetic retinopathy, or is deemed at risk for glaucoma or macular degeneration. Blindness can be caused by any of these conditions.

Is Medicare covered for contact lenses and eyeglasses?

Original Medicare doesn’t cover corrective lenses in most cases. If you need contact lenses or eyeglasses after cataract surgery, Medicare Part B might cover your prescription.

Is Medicare Advantage or Medigap able to cover vision care?

Medigap, also known as Medicare supplemental insurance, doesn’t cover routine eye exams for people who haven’t been identified as high risk.

Some Medicare Advantage Plans, also known as Medicare Part C and provided through private insurers, may cover eye exams even when you’re not in a high-risk group. Ask about vision coverage from private insurers offering Medicare Advantage Plans. This could include contact lenses and eyeglasses as well as eye examinations.

However, a routine eye exam doesn’t usually cost more than a major medical expense so choosing Medicare Advantage for this coverage might not be the best choice.

What other way can you get coverage for your eyes?

Private vision insurance, provided by many employers and also available to individuals, is a way to spread out over the year some of the costs of eye exams, eyeglasses and contacts, and possibly save money. For as little as $20 per month, you might be eligible for vision insurance.

Some people may find it more practical to pay out-of-pocket for their eye exams. A dilated exam of the eyes, which includes a vision check, glaucoma test and other assessments, costs about $200 for a brand new patient, or $128 for an existing patient.

For people with low incomes, Medicaid in most states covers routine eye exams. Although some states may have copays they are usually very small.

EyeCare America is a program offered by the American Academy of Ophthalmology to eligible individuals 65 years and older. It provides free eye exams by volunteer ophthalmologists, with little or no out-of pocket costs. This program is open to anyone with a reasonable income.