Original Medicare does not
include routine vision care, which means it generally will not pay for eyeglasses, contact lenses, or eye exams. This means you are typically responsible for 100% of the costs associated with your eyeglasses under Original Medicare.
If you have a Medicare Advantage plan or certain Medicare Supplement plans, you might have additional coverage for vision . Talk to a Senior Markets Specialist in your area if you are unsure of your coverage and to get help navigating your Medicare coverage options.
Does Medicare Cover Eyeglasses for Cataracts?
The only time Original Medicare will pay for eyeglasses is after cataract surgery to implant intraocular lenses. These corrective lenses include one pair of eyeglasses with standard frames or contact lenses. In this instance, Medicare Part B, the component of original Medicare that covers outpatient services, will cover one set of corrective eyeglasses, or contact lenses.
You will have to pay 20 percent of the Medicare-approved amount for corrective lenses after each cataract surgery with an intraocular lens and pay the Part B deductible.
However, if you have a Medicare Advantage plan that offers vision care, you may have some coverage. It’s best to check your benefits to know for sure what costs you will be responsible for.
Does Medicare Cover Eye Exams for Diabetics?
If you are diabetic, Original Medicare will cover an eye exam for diabetic retinopathy once each year. This eye exam is covered under Medicare Part B (Medical Insurance). The eye exam for diabetic retinopathy must be performed by an eye doctor who is legally licensed to do the tests in your state.
You still pay 20% of the Medicare-approved amount for the diabetic eye exam, and the Medicare Part B deductible applies. If you receive the eye exam in a hospital outpatient setting, you are liable for a copayment.
If you are unsure of your benefits or are interested in changing your Medicare plan to receive more benefits, contact an agent specializing in Medicare to go over your options.
How Do I Get Vision Coverage with Medicare?
Original Medicare will not typically cover the costs for eye exams, eyeglasses and contact lenses.
You could get vision coverage under a Medicare Advantage Plan, however, or certain Medicare supplement plans (Medigap plans). These plans are offered by private, Medicare-approved insurance companies, and often combine the benefits of Original Medicare (Parts A & B) with additional benefits like Medicare Prescription Drug Coverage (Part D) and services like routine eye exams and eyeglasses.
If you are unsure of your benefits or would like to see about changing your Medicare plan to include more services, you can talk to a licensed Senior Market Specialist in your area to get help navigating your Medicare options. We are available to help you over the phone and via our easy contact form found on our Contact Us page.
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