Does Medicare Cover Eye Exams? (2024)

Taking care of and monitoring the state of your vision is an important part of your overall wellbeing and safety. It’s normal for your vision to blur with age, so regular eye exams are a key part of keeping your eyes healthy and your vision clear. So, does Medicare help take care of the costs of these services? We’re here to open your eyes to the facts.

Original Medicare is divided into separate parts that cover different services. Medicare Part A (hospital insurance) covers hospital stays and home health care. Medicare Part B (medical insurance) pays for doctor visits, outpatient care and some preventive services. While Medicare may help pay for certain services related to an illness or injury, it does not cover routine eye exams to correct vision.

This is where a Medicare Advantage plan can help. Medicare Advantage, also known as Part C, are Medicare-approved plans offered by private insurance companies. They offer bundled benefits for things not covered in Medicare Part A or Part B. This usually includes dental, hearing and vision. Without a Medicare Advantage plan, you will be responsible for 100% of the cost of your eye exam, eyeglasses and contact lenses.

Vision Services Covered by Medicare

While Medicare doesn’t cover routine vision services, including exams and eyeglasses, Part B can help pay for certain treatments. Typically, these services are related to illnesses you may be at risk for, including:

• Glaucoma – Part B coverage includes one glaucoma test every 12 months if you’re at high risk for this eye disease. To qualify, you must meet at least one of these requirements
  • You have been diagnosed with diabetes.
  • You have a family history of glaucoma.
  • You are African American and aged 50 or over.
  • You are Hispanic and aged 65 or over.

• Diabetes – Part B helps pay for an annual diabetic eye exam if you have diabetes or diabetic retinopathy. To qualify, the exam must be done by an eye doctor who’s authorized to do this test in your state.
• Macular degeneration – Part B may cover certain tests for age-related macular degeneration and needed treatment for it.

Your Costs Associated with Vision Treatment

The costs that come with vision treatment can vary a lot. Some common factors include:

• The type of treatment that’s needed.
• Where you live.
• Your individual provider.
• Any follow-up appointments.

If the treatments you receive are routine services meant to correct your vision, you will pay 100% of the cost. However, if treatment is related to any illnesses you are at high risk for, you’ll pay 20% of the Medicare-approved amount once you meet your Part B deductible.So, let’s say the total cost of your doctor visit and treatment is $500, you would pay $100 (20% of $500) as a copay after you’ve met your deductible. Medicare would then cover the remaining $400.

Medicare Supplemental Insurance may help cover any copayment for you. Also known as Medigap, it’s extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs. Generally speaking, you must have Original Medicare (Part A and B) to buy a Medigap policy.

Alternatives to Original Medicare Coverage

Taking care of your eyes shouldn’t have to come at a cost. Thankfully, there are options to help ease the financial burden. Medicare Advantage (Part C) plans are private, bundled plans that can help pay for routine eye exams, eyeglasses and contact lenses. Most also have out-of-pocket maximums that are meant to protect you from high medical costs.

If you’re a veteran, you may qualify for eye care benefits through the VA healthcare system. You can also ask your eye doctor if there are any discount programs available to help you save money.Eye exams aren’t just about seeing well. Many eye conditions can be prevented or managed through early detection. So find the help you need for your vision care coverage – and make your eye health a priority.

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Disclaimers

Sources
Medicare.gov - Routine Eye Exams
Medicare.gov - Eyeglasses and Contact Lenses
Medicare.gov - Eye Exams for Diabetes
Medicare.gov - Glaucoma Screenings