Medicare covers some eye tests and vision services, but not all of them

Medicare Part B covers a dilated eye exam once every 12 months if you have diabetes, glaucoma, age-related macular degeneration, or a family history of glaucoma. It also covers a one-time screening for glaucoma if you are at high risk. These exams are covered at no cost to you after you meet your Part B deductible.

For other eye exams — routine vision checks to see if you need glasses or contacts — Medicare does not pay. If you want an eye exam just to update your prescription, you pay the full cost yourself. This is the main gap most people discover when they turn 65.

Medicare also does not cover eyeglasses, contact lenses, or most eye surgery for vision correction. If you need cataract surgery, Medicare Part B will pay for the procedure itself, but not for the eyeglasses or special lenses you may need afterward.

Key Takeaways

  • Medicare Part B covers one dilated eye exam per year if you have diabetes, glaucoma, age-related macular degeneration, or a family history of glaucoma.
  • A one-time glaucoma screening is covered if you are at high risk, with no cost after your Part B deductible.
  • Routine eye exams to check your vision or update your glasses prescription are not covered by Medicare.
  • Eyeglasses, contact lenses, and vision correction surgery (like LASIK) are not covered by any part of Medicare.
  • Some Medicare Advantage plans include vision coverage that Original Medicare does not, so check your plan documents.

Which eye exams Medicare Part B covers

Medicare Part B covers a dilated eye exam once every 12 months if you have one of four conditions: diabetes, glaucoma, age-related macular degeneration, or a family history of glaucoma. Your eye doctor must perform the exam and document that you have one of these conditions in your medical record. The exam is covered at 100 percent after you have paid your Part B deductible for the year.

Medicare also covers a one-time screening for glaucoma if you are at high risk. This screening is separate from the yearly dilated exam and is also covered at 100 percent after your deductible. Your doctor will determine whether you meet the criteria for high risk based on your age, medical history, and family history.

If you have cataract surgery, Medicare Part B covers the surgery itself and the intraocular lens (the artificial lens placed in your eye during surgery). You pay 20 percent of the cost after your deductible. However, Medicare does not cover the eyeglasses or special contact lenses you may need after surgery to see clearly at all distances.

What Medicare does not cover for vision

Routine eye exams — the kind where you sit in the chair and read letters on a chart to see if you need glasses — are not covered by Medicare. If your only reason for seeing an eye doctor is to update your prescription for eyeglasses or contacts, you pay the full cost out of pocket. This includes exams at your eye doctor's office, at a retail chain like Walmart or Costco, or at a vision center inside a pharmacy.

Eyeglasses and contact lenses are not covered by Medicare, even if you need them after cataract surgery or another covered procedure. You can purchase them from any optical retailer, and some offer discounts to Medicare beneficiaries, but Medicare will not pay any part of the cost.

Vision correction surgery — including LASIK, PRK, and other procedures to reshape your cornea — is not covered. Nor is surgery to correct presbyopia (age-related difficulty focusing on close objects). If you choose these procedures, you pay the entire cost yourself.

How to know if your eye exam is covered

Before you schedule an eye exam, tell your doctor's office that you have Medicare and ask whether the exam will be covered. Give them the specific reason for your visit: a routine check-up, a follow-up for diabetes, a glaucoma screening, or something else. The office staff can tell you whether that type of exam is covered under your plan.

Bring your Medicare card to your appointment. Your eye doctor will need to verify your coverage and document the medical reason for the exam in your record. If the exam is covered, you should not receive a bill after you meet your deductible. If you do receive a bill, contact your doctor's office to ask why.

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage may be different. Some Medicare Advantage plans include routine vision exams and eyeglasses as part of their benefits. Check your plan documents or call your plan's customer service line to find out what vision services are covered under your specific plan.

Medicare Advantage plans and vision coverage

Original Medicare (Part A and Part B) does not cover routine eye exams or eyeglasses. However, many Medicare Advantage plans add vision coverage as an extra benefit. Some plans cover routine eye exams once or twice per year, and some also cover a set amount toward eyeglasses or contact lenses each year.

The amount of coverage varies widely from plan to plan. One plan might cover a routine eye exam and $100 toward frames and lenses each year. Another might cover two exams per year and $150 toward eyeglasses. A few plans cover nothing for vision. You need to read your plan's Summary of Benefits and Coverage document to know what you have.

If you are thinking about switching to a Medicare Advantage plan, or if you already have one, ask the plan directly what vision services are covered. You can also compare plans on Medicare.gov during the annual enrollment period (October 15 to December 7 each year) and see the vision benefits listed for each plan in your area.

Other ways to pay for eye care

If you need an eye exam or eyeglasses and Medicare does not cover them, you have several options. Some optometrists and ophthalmologists offer discounts to Medicare beneficiaries or to seniors. Ask when you call to schedule an appointment.

Retail chains like Walmart, Costco, and LensCrafters often have lower prices for eye exams and eyeglasses than independent practices. Costco and Sam's Club require a membership, but their vision centers are open to non-members for eye exams and glasses purchases. Online eyeglass retailers can also be less expensive than brick-and-mortar stores if you already know your prescription.

Some community health centers and charitable organizations offer free or low-cost eye exams and eyeglasses to seniors with limited income. Contact your local Area Agency on Aging to ask whether programs like this operate in your area. You can find your local agency by calling the Eldercare Locator at 1-800-677-1116.

What to ask your eye doctor

Before your appointment, write down these questions to ask your eye doctor or their office staff:

  • Is this exam covered by Medicare, and if so, what is the medical reason for the coverage?
  • What will I owe out of pocket after my deductible?
  • If I need eyeglasses or contacts, does Medicare cover any part of the cost?
  • Do you offer a discount for seniors or Medicare beneficiaries?
  • If I have a Medicare Advantage plan, can you verify what vision services my plan covers?

When to see an eye doctor

You should see an eye doctor right away if you notice sudden changes in your vision, eye pain, flashing lights, new floaters (spots that drift across your field of vision), or a shadow or curtain over part of your vision. These can be signs of serious eye problems that need prompt treatment.

If you have diabetes, you should have a dilated eye exam at least once per year, even if your vision seems fine. Diabetes can damage the blood vessels in your eyes without causing symptoms you notice. If you have glaucoma or a family history of glaucoma, regular exams are also important because early treatment can prevent vision loss.

If you have not had an eye exam in more than a year and you have any of the conditions Medicare covers (diabetes, glaucoma, age-related macular degeneration, or a family history of glaucoma), schedule an appointment. That exam will be covered by Medicare.

Frequently Asked Questions

Does Medicare cover glasses after cataract surgery?

No. Medicare covers the cataract surgery and the artificial lens placed in your eye, but not the eyeglasses or special contact lenses you may need afterward to see clearly at all distances. You pay for those yourself.

Will Medicare pay for an eye exam if I just want to update my glasses prescription?

No. Medicare only covers eye exams for specific medical conditions: diabetes, glaucoma, age-related macular degeneration, or a family history of glaucoma. A routine exam to check your vision or update your prescription is not covered.

Does my Medicare Advantage plan cover eye exams and glasses?

It depends on your specific plan. Some Medicare Advantage plans include routine eye exams and a set amount toward eyeglasses each year, but others do not. Check your plan's Summary of Benefits and Coverage document or call your plan's customer service line to find out.

What if I cannot afford an eye exam or eyeglasses?

Contact your local Area Agency on Aging at 1-800-677-1116 to ask about free or low-cost vision services in your area. Retail chains like Costco and Walmart often have lower prices than independent eye doctors. Some community health centers also offer discounted exams and eyeglasses to seniors with limited income.

How do I know if my eye exam will be covered before I go?

Call your eye doctor's office and tell them the reason for your visit. If you have diabetes, glaucoma, age-related macular degeneration, or a family history of glaucoma, the exam should be covered. If you are just getting a routine check-up or updating your glasses prescription, it will not be covered. Bring your Medicare card to your appointment so the office can verify your coverage.