What to Know About Medicare and Vision Care (2024)

Vision problems are a common health concern as you age. With the right health insurance, you can access the best vision care. Most older people have Medicare insurance, but does Medicare cover eye exams? The short answer is yes, but only for specific conditions.

What Does Medicare Cover?

Medicare is a government-funded health insurance plan for people aged 65 and older. It’s also available for younger people with disabilities and people with end-stage renal disease. There are four parts to the program.

Part A. Also called hospital insurance, Part A of Medicare covers hospital stays, hospice care, some home healthcare, and stays in a skilled nursing facility. These are inpatient services.

Part B. Known as medical insurance, Medicare Part B covers your outpatient medical services. These are your doctor’s appointments, urgent care clinic visits, tests, blood tests, and supplies that are medically necessary to diagnose or treat your condition.

Part B also covers preventive services, like vaccines, annual checkups, and screenings for cancer and other diseases. Medicare vision coverage falls under Part B preventive services, but only for some conditions. Part B also includes coverage for inpatient or outpatient mental health services, limited prescription drug coverage, ambulance services, and specific medical equipment.

Part C. Private insurance companies provide Part C coverage which bundles Parts A, B, and sometimes D with extra benefits you don’t get under traditional Medicare. These benefits can include dental coverage, vision coverage, gym memberships, over-the-counter drugs, and many other options. This plan is called Medicare Advantage. Medicare Advantage plans require you to get your health care from one of the providers in the plan’s network.

Part D. This section offers prescription drug coverage. All plans include a wide variety of drugs that most people take, but each has a list of specific drugs covered. If they don’t cover a drug, they often have a similar one available. Part D helps pay for your medications and can lower costs.

Does Medicare Cover Eye Exams?

Medicare vision coverage is limited to preventive screenings for some conditions and diagnosing tests under Part B insurance. Routine eye exams aren’t covered, though, so you’ll pay out of pocket for all fees unless you have a Medicare Advantage plan with coverage.

Medicare vision services covered under Part B are:

Tests for serious eye problems, like Glaucoma or Cataracts. If you have eye or vision problems, Medicare will cover the cost of tests to diagnose the condition, even if your results are negative.

Yearly glaucoma test.Glaucoma is a group of eye conditions where the optic nerve in the back of your eye becomes damaged. You’re more likely to get glaucoma when you’re older, and if you have a family history of glaucoma, you have diabetes, or you’re African American or Hispanic. Part B covers a yearly glaucoma test if you have a high risk of getting the condition.

Yearly diabetes-related exams. Diabetes can cause health complications, including a vision problem called diabetic retinopathy. High blood sugar over time damages the blood vessels in your eye, causing them to swell, leak, or close and affect your eyesight. If you have diabetes, Part B will cover a yearly exam to check your eyesight and screen for diabetic retinopathy.

Macular degeneration screening. Macular degeneration happens when a part of your retina, called the macula, becomes damaged. It causes loss of central vision and is a common cause of vision problems in older people. With Medicare Part B, you have coverage for preventative screening and some diagnosing tests for macular degeneration.

What Does Medicare Cover for Eyes?

Medicare doesn’t cover glasses or contacts unless you have extra benefits under a Medicare Advantage plan. Without Part C, you pay for 100% of the costs of contacts or eyeglasses. Original Medicare does have some other specific vision benefits, though.

Cataract surgery. Medicare Part B will cover surgery to correct vision problems from ongoing eye conditions, like cataract surgery. Medicare will only cover this surgery if you have a traditional or laser surgery, though.

Glasses after cataract surgery. Once you have cataract surgery, Medicare Part B will pay for one set of contact lenses or standard eyeglasses frames. You can get upgraded frames, but you’ll have to pay the extra cost. The eyeglasses or contacts supplier must also be Medicare-approved for your products to qualify.

Other services under Medicare Advantage. Some Medicare Advantage plans offer routine exams, eyeglasses and contacts, eye care supplies, and other tests and treatments.

The specific coverage details are different depending on the plan. You’ll want to check the details to understand what kind of vision coverage you’re getting.

Medicare Vision Services Fees

While you can usually get Medicare Part A for free based on your tax history, you must pay Part B premiums, even if you don’t use it. Plus, Part B includes other fees, so your Medicare vision services aren’t totally free.

On top of these monthly premiums, you also have to pay a yearly deductible and coinsurance. This means you pay a certain amount for services in the year, and Medicare only starts paying once you reach that threshold. After you pay the deductible, you’ll also have to pay for 20% of each vision service you access.

Your doctor’s status with Medicare can affect your costs, too. For example, if you use a doctor who doesn’t work with any Medicare program, you’ll have to pay all the costs directly, and Medicare won’t pay for any.

Some doctors will accept the Medicare rate on a case-by-case basis, but they might make you pay the entire amount upfront instead of waiting for Medicare to pay its share. You can submit those claims to Medicare for reimbursement, but your doctor might not help you or submit claims on your behalf. Your doctor can also charge up to an extra 15% of the Medicare amount.

What to Know About Medicare and Vision Care (2024)

FAQs

Does Medicare cover anything for the eyes? ›

Routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare covers: Surgical procedures to help repair the function of the eye due to chronic eye conditions.

Which medicare plan has the best eye coverage? ›

Best Medicare Advantage options for vision care
Medicare Advantage planUpside
Blue Cross Medicare Advantage ValueUnlimited number of contacts up to maximum dollar amount
Cigna Preferred Medicare$200 annual eyewear benefit
Humana Gold Plus$200 annual eyewear benefit
Kaiser Enhanced 1 Plan$500 eyewear benefit every two years
2 more rows
Jan 23, 2024

How many eye exams does Medicare cover per year? ›

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.

Does Medicare cover eyeglasses for seniors with Medicare? ›

Does Medicare cover eyeglasses? No, Medicare usually doesn't cover the cost of eyeglasses or contact lenses. But if you need cataract surgery—and an intraocular lens (IOL) is implanted—Part B will help cover the cost of 1 set of corrective lenses.

Which lens does Medicare pay for? ›

Original Medicare and Medicare Advantage will cover a standard intraocular lens (IOL). This small disc replaces a natural lens that's been blurred or clouded by a cataract.

What part of cataract surgery is not covered by Medicare? ›

Medicare covers medically necessary cataract surgery with IOLs. Medicare won't cover advanced technology lenses or elective surgery primarily to correct vision from nearsightedness or astigmatism, called “refractive lens exchanges.” Talk with your doctor about your options and costs before your surgery.

Who has the best vision plan for seniors? ›

What is the best vision insurance for seniors?
  1. Direct Vision Insurance. Direct Vision is a vision insurance company that offers plans with low premiums, so it can be a good place to start. ...
  2. VSP. VSP is another popular option in the world of vision insurance for retirees and seniors. ...
  3. Spirit Dental and Vision Insurance.

What is the most highly rated Medicare Advantage plan? ›

Our Top Medicare Advantage Plans
  • Best Consumer Reputation: Blue Cross Blue Shield.
  • Best Nationwide Coverage: Humana.
  • Best Local Support Services: Aetna.
  • Largest Provider Network: UnitedHealthcare.
  • Best Additional Benefits: Cigna.
  • Best Overall CMS Rating: Anthem.

What does Medicare Part B cover in vision? ›

Original Medicare Parts A and B do not cover vision care, except in certain circumstances. For example, Part B partially covers eye exams if you're at higher risk for eye complications such as glaucoma. Original Medicare also covers some medically necessary eye surgeries, such as cataract removal.

Does Medicare cover an OCT scan? ›

Medicare covers posterior OCT if the patient presents with a complaint that leads you to perform this test or as an adjunct to management and treatment of a known disease.

Will Medicare pay for glasses in 2024? ›

There's one exception: If you have cataract surgery, Medicare Part B will cover one set of corrective lenses if you need them after your intraocular lens is implanted. The Part B deductible, $240 in 2024, will apply, and you'll owe a copayment of 20% of the Medicare-approved amount for vision correction.

How much does AARP save you on glasses? ›

AARP® Vision Discounts provided by EyeMed

You save 50% on prescription lenses with the purchase of a frame at LensCrafters, 30% on complete pair of glasses (frames and lenses) at Glasses.com, and you save an additional $10 on a complete pair at Target Optical.

How many pairs of glasses can you get with Medicare? ›

With this coverage, Original Medicare beneficiaries can receive one pair of standard frame eyeglasses or a single set of contact lenses. Once you pay your Part B deductible, you'll be responsible for 20% of the Medicare-approved amount after each cataract surgery.

What does Medicare not cover for the elderly? ›

There are some things Original Medicare won't cover. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine physical exams.

Do you pay for glasses over 65? ›

What's more, over 60s who receive certain benefits are eligible for a voucher to pay towards the cost of glasses or contact lenses. The benefit most commonly claimed by over 60s which will make you eligible is the Guarantee Credit part of Pension Credit.

Does Medicare Part B cover vision? ›

NARRATOR: Medicare Part A and part B do not provide coverage for dental, vision and hearing.

Is vision therapy covered by Medicare? ›

Medicare covers rehabilitation services for members with a primary vision impairment diagnosis when provided by a qualified occupational or physical therapist (or a person supervised by a qualified therapist) and when provided according to a written treatment plan written by a physician.

Does Medicare Plan G cover vision? ›

Plan G doesn't cover dental, vision, hearing exams or services, or prescription drug services.

Does Medicare pay for eye injections? ›

Will Medicare cover eye injections? Traditional Medicare does cover eye injections for age-related macular degeneration and diabetic retinopathy through your Part B coverage. You will not need a referral or authorization to receive these treatments.

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