Medicare and eye exams: What’s covered and what isn’t
Learn what vision services Medicare does and does not cover, including eye exams, eyeglasses and more.
As we get older, our vision changes – it’s perfectly normal. However, it’s important to stay on top of routine eye care. This is especially true for those 65 and up, who are more likely to experience vision loss and eye disease.
A trip to the eye doctor can help you catch and prevent issues or help address those you do have. But what about coverage? If you’ve got Medicare, what are your options?
Let’s go over what vision services Original Medicare covers, what it doesn’t, and coverage alternatives that can help you get the help you need.
Parts of Medicare that cover eye exams
Does Medicare cover eye exams? In general, Original Medicare doesn’t pay for routine eye exams for those with eyeglasses or contact lenses. While a basic vision test is included in your initial Welcome to Medicare visit, it’s only offered once during the first year of having Part B coverage. Additionally, Medicare pays for diagnostic eye tests if you have a medical condition of the eye.
However, eye exams are covered if they are medically necessary. For instance, Part B will cover an annual exam for those with diabetes and other chronic conditions. Additional diagnostic exams, like screenings for cataracts, glaucoma or macular degeneration, may also be covered.
Medicare Part C for vision coverage
A Medicare Advantage (Part C) plan usually covers additional benefits, such as routine eye exams. Typically purchased through private health insurance companies, Part C works as an alternative to Original Medicare. These plans cover everything Original Medicare does, but with added benefits. However, each plan is different. Before enrolling, make sure to thoroughly review additional benefits to ensure you get the vision coverage you need.
Does Medicare pay for eyeglasses?
Original Medicare typically does not pay for eyeglasses and contacts. However, there is coverage for those who’ve had an intraocular lens (IOL) implanted during cataract surgery. And if you still need a correction lens after your procedure, Medicare will cover one set of Medicare-approved glasses or contacts.
Unlike Part B, a Medicare Advantage plan can assist with eyewear and contacts in different ways. It all depends on your plan, but some benefits may include an eyewear allowance or even a prepaid benefit card that you can use for multiple services, including eyewear and contacts.
HealthPartners UnityPoint Health Medicare Advantage members: Your plan includes select eye care coverage and additional benefits. Call your Member Services team to learn more.
Types of eye exams covered by Medicare
As we mentioned earlier, Medicare will cover eye exams for beneficiaries under specific circumstances. But what are those medical necessities and does your situation qualify? Here’s what you can expect.
Eye exams for people with diabetes
Those who have diabetes are more likely to suffer from eye diseases, such as diabetic retinopathy, cataracts, glaucoma and more. Regular eye exams are a great way to catch and treat these conditions early. This is why Original Medicare covers annual eye exams for those with diabetes. These specific exams are typically for diabetic retinopathy, and they must be done by a Medicare-approved doctor who’s legally allowed to test in your state.
Since Medicare covers exams for people who have diabetes, what about eyeglasses? Unfortunately, while Medicare may cover treatment for specific diabetic eye conditions, this does not include glasses or contacts. With any sort of eyewear or contacts, you will most likely pay 100% out of pocket unless you have a Medicare Advantage plan that offers specific vision benefits.
Glaucoma testing and eye exams
Does Medicare cover eye exams for glaucoma? Yes, but you must meet specific guidelines. Original Medicare will cover an annual glaucoma test if you’re considered high-risk for this condition. According to Medicare.gov, this includes people with diabetes or a family history of glaucoma, as well as African Americans aged 50 and older or people of Hispanic descent age 65 and older.
Getting the coverage you need for eye exams
While Original Medicare has its limitations, that doesn’t mean you’re out of luck. Vision care is important, and you have options. A Medicare Advantage plan can help you get the care and coverage you need, from routine exams to eyewear.
Have more Medicare questions?
Our experts are here to help you find the best Medicare plan for the way you live. Learn all about your HealthPartners UnityPoint Health Medicare options.
