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En español | Original Medicare offers limited vision coverage related to particular chronic conditions.
It does not pay for regular eye exams to check prescriptions for glasses and contact lenses, nor for glasses or contacts you purchase as a result. You are responsible for the full cost of these services unless you have a separate vision care policy.
Many Medicare Advantage plans offer routine vision care as an additional benefit, although you may have to pay extra premiums.
Medicare Part B, the component of original Medicare that includes doctor visits and outpatient services, does cover diagnostic and preventive eye exams in these circumstances:
If you have diabetes, Medicare will cover an annual eye exam to check for diabetic retinopathy. The risk of this disease, caused by damage to blood vessels at the back of the eye, increases the longer a patient has lived with diabetes.
An annual glaucoma test is covered if you are at high risk for the disease. The risk factors Medicare considers are whether you have diabetes, have a family history of glaucoma, are older than 50 and African American, or are older than 65 and Hispanic.
Medicare will pay for certain diagnostic testing and treatment of age-related macular degeneration if you have the disease.
In all these situations, you will have some out-of-pocket costs: 20 percent of the Medicare-approved rate for the test or treatment and an additional copayment if the procedure is done in a hospital outpatient setting. The Part B deductible applies, which means Medicare will start paying its share once you’ve reached your annual deductible amount.
Original Medicare also will cover some of the costs of medically necessary cataract surgery and of new glasses or contact lenses you require as a result.
You typically will pay 20 percent coinsurance for the procedure and for the corrective lenses. Just make sure your lens supplier is enrolled in Medicare. The Part B deductible applies.
Editor's note: This article was originally published on July 15, 2015. It has been updated with the latest information regarding Medicare coverage in 2020.
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