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Does Medicare cover eye exams?

En español | Technically, no. Medicare doesn’t cover routine eye exams, eyeglasses or contact lenses, nor does it cover exams to determine prescriptions.

However, if you’re in certain high-risk groups, it does cover eye exams to check for specific conditions. It also covers diagnosis and treatment of eye conditions such as cataracts and cataract surgery and offers limited coverage for glasses after cataract surgery. 

What eye exams does Medicare cover?

Medicare covers eye exams to check for specific medical conditions, such as:

  • If you have diabetes, Medicare will cover an annual eye exam to check for diabetic retinopathy, which comes from damage to blood vessels at the back of the eye. Your risk increases the longer you live with diabetes. A licensed eye doctor in your state must perform the exam.
  • If you’re at high risk for glaucoma, a series of eye conditions that damage the optic nerve, Medicare will cover an annual glaucoma test. High risk is considered someone with diabetes, who has a family history of glaucoma, is African American and 50 or older or is Hispanic and 65 or older.
  • If you have age-related macular degeneration, an eye condition that causes damage to a small spot near the center of the retina, Medicare will pay for certain diagnostic tests and treatment, including some types of treatment using drug injections.

How much do I pay for covered eye exams?

After you pay the annual Medicare Part B deductible, which is $233 in 2022, you pay 20 percent of the Medicare-approved amount for tests and services.

Does Medicare Advantage cover eye exams?

If you choose to get a private Medicare Advantage plan rather than original Medicare, you’ll have some coverage for eye exams, glasses and contact lenses, usually without a copayment. But you may have to pay if your expenses exceed plan limits. The Kaiser Family Foundation reported an average cap of $160 in 2021.

To check out plans with vision coverage in your area, go to the Medicare Plan Finder and type in your zip code. In the Plan Type drop-down menu, click ◯ Medicare Advantage Plan and hit the Apply button to register your choice.

You then may be asked to choose your county if your zip code spans more than one county. When you click Start, you can identify if you receive financial aid and see an option to compare drug costs among plans. This doesn’t include vision costs.

From there, you can link to a list of all Medicare Advantage plans in your area. A green check mark notes ✓ Vision in the Plan Benefits list. You can narrow the list by clicking on Filter by: Plan Benefits, checking the box beside ☐ Vision coverage, and hitting the Apply button.

For more information about the plan’s vision coverage, click Plan Details and either scroll down to Extra Benefits or click on the tab with that name. If a plan has copayments or limits to coverage, you’ll see those listed in the Vision section.

You also can visit a plan’s website or contact the plan directly for more information. Some plans require using an in-network provider and getting prior authorization for some vision services.

Keep in mind

You can get help to pay for eye exams in other ways.

Medigap plans. A few Medigap companies let you add an optional package of extra benefits that cover some in-network vision, dental and hearing exams and one pair of glasses or contacts each year, up to an annual limit. All Medigap plans will pay the 20 percent Part B coinsurance for eye exams covered by Medicare.

Other insurance. You can look into retiree insurance policies or veterans’ health benefits that cover vision care, sign up for a discount program or buy standalone vision insurance. AARP members are eligible for three vision insurance plans through EyeMed MyVision Care. Members can explore rates and plan benefits, which vary by state, on the EyeMed site.

If you’re new to Medicare, a logical first step might be to take the simple vision test as part of your free Welcome to Medicare checkup. You can do this within the first 12 months of signing up for Medicare Part B.

Updated September 27, 2022

     

        


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