Medicare Coverage for Eye Exams and Treatment

Keeping your vision as clear as possible and your eyes healthy is essential for your overall well-being. Wearing sunglasses, protecting your eyes from the elements and taking care of your overall health are good ways to help protect your eyes. But regular exams are important too.

Routine check-ups help maintain your vision and detect potential eye problems early. Let’s take a look at how Medicare covers eye exams and treatments and how to find coverage for what it doesn’t.

Does Medicare Cover Eye Exams?

Original Medicare pays for a simple vision test as part of the “Welcome to Medicare” exam, but it doesn’t cover routine eye exams.^1,2 It pays for eye check-ups only if you have specific illnesses.

Routine eye exams and glasses

You’ll have to pay the full cost of eye exams, eyeglasses and contacts when they aren’t related to specific illnesses or surgeries.³

Eye Conditions Covered Under Medicare

Medicare Part B will pay for eye exams, tests and other treatments related to specific diseases and conditions listed below. In most cases, you will still have to pay some of the cost for these. After you meet your Original Medicare Part B deductible, you’ll have to pay 20% of the Medicare-approved amount for these tests, exams, devices and treatments.

Cataract Surgery

Cataracts can make vision cloudy or hazy. Original Medicare may cover cataract surgery, which removes the cloudy lens from the eye and replaces it with an artificial intraocular lens.⁴

Diabetic eye exams

If you have diabetes, Medicare Part B covers one eye exam for diabetic retinopathy each year. This condition can cause vision loss and blindness in people with diabetes.⁵

Glaucoma testing

Glaucoma is a group of diseases that can cause vision loss and blindness by damaging the optic nerve. Medicare Part B will cover an annual glaucoma test if you are at high risk.⁶

Macular degeneration testing

Age-related macular degeneration (AMD) happens when aging causes damage to the macula. If your doctor suspects that you have AMD, Medicare Part B may cover specific tests to diagnose it. If you have AMD, Medicare Part B may pay for treatment, including certain injectable drugs.⁷

Other eye treatments

Original Medicare may cover other treatments for eye conditions as needed. These could include surgery to repair the eye or area around the eye from an accident, injury or illness. Some examples might include surgery to repair a detached retina or a cornea transplant.

Medicare Advantage Plans with Vision Benefits

A Medicare Advantage plan is an all-in-one plan with both Medicare Part A and Part B coverage. These plans may also have extra benefits built in like dental and vision coverage, as well as prescription drug coverage. Not all plans include vision, so it’s important to check if the plan you’re considering does.

Medicare Supplement Plans and Vision Benefits

Medicare supplement insurance is an insurance policy you buy from a private insurance company to help pay for copayments, coinsurance and deductibles not covered by Original Medicare. These plans don’t include vision insurance benefits. However, Medicare supplement insurance plans can help cover remaining out-of-pocket costs for eye condition treatments that are covered under Medicare.

Supplemental Vision Insurance

A supplemental vision insurance plan can help pay for routine exams, glasses and contacts that are not covered by Original Medicare. Plans can help cover some or all of the costs based on your coverage.

You may have other options for getting vision insurance as well. Check with your carrier to see if you have access to any value-added extras that offer savings on eye exams or eyewear. You may also be able to add vision benefits as a rider to another policy you already have, such as dental.

How to Maintain Healthy Vision

Regular eye exams are important in maintaining healthy vision because they can help find serious eye conditions early on. Your eye doctor will check for conditions such as cataracts, diabetic retinopathy, glaucoma and macular degeneration.

Apart from that, you’ll want to prioritize eye health with a healthy lifestyle. Exercise improves blood flow, delivering vital nutrients and managing conditions like diabetes and high blood pressure, which harm vision. A diet rich in leafy greens (spinach, kale) provides antioxidants (lutein, zeaxanthin) that help protect the macula from damaging light. Omega-3s from fish (salmon, halibut) support retinal health and prevent dry eye. Wear sunglasses with 100% UVA/UVB protection to shield eyes from harmful UV rays, preventing cataracts and macular degeneration.

Smoking severely damages eyesight. Toxins harm blood vessels supplying the retina and optic nerve, increasing the risk of age-related macular degeneration (AMD) and cataracts, which lead to vision loss. It’s important to quit smoking to preserve vision and lower the risk of these debilitating eye diseases.8

Medicare Eye Exams FAQs

Q1. Does Medicare cover laser eye surgery?

Medicare Part B does not cover laser eye surgery, also known as LASIK because it is considered elective surgery that is not medically necessary.

Q2. How often does Medicare pay for eye exams?

While Medicare doesn’t cover routine eye exams, it provides coverage for exams related to specific medical conditions. For instance, individuals with diabetes are eligible for a diabetic eye exam once annually. Similarly, Medicare covers glaucoma screenings once every 12 months for those at high risk. Other disease-related eye exams and treatments may also be covered.

Q3. Are eyeglasses covered after cataract surgery?

If you have cataract surgery, Medicare Part B will cover one pair of eyeglasses or one set of contact lenses.³

Supporting Your Vision Care Needs

No matter which insurance plan you choose for eye exams and treatment, it’s important to take care of your eyes. Keeping our vision as clear as possible as we age can improve our overall well-being. It allows us to stay active and connected to our environment.

When considering your vision coverage alongside Medicare, it’s helpful to explore the different avenues available. You can select individual vision plans or look for other insurance plans, like some dental insurance policies, that allow you to add on vision benefits.

You might also find it beneficial to investigate the broader landscape of Medicare coverage and supplemental plans to ensure a well-rounded approach to your healthcare. If you have questions, we can help you learn more about what Medicare covers.

Sources

¹ Medicare.gov. Web page: “Welcome to Medicare” preventive visit. Retrieved Feb. 11, 2025, from https://www.medicare.gov/coverage/welcome-to-medicare-preventive-visit

² Medicare.gov. Web page: Eye exams (routine). Retrieved January 31, 2025, from https://www.medicare.gov/coverage/eye-exams-routine

³ Medicare.gov. Web page: Eyeglasses & contact lenses. Retrieved Jan. 31, 2025, from https://www.medicare.gov/coverage/eyeglasses-contact-lenses

⁴ Medicare.gov Web page: Cataract Surgery. Retrieved Feb.12, 2025, from https://www.medicare.gov/coverage/cataract-surgery

⁵ Medicare.gov. Web page: Eye exams (for diabetes). Retrieved Jan. 31, 2025, from https://www.medicare.gov/coverage/eye-exams-for-diabetes

⁶ Medicare.gov. Web page: Glaucoma screenings. Retrieved Jan. 31, 2025, from https://www.medicare.gov/coverage/glaucoma-screenings

⁷ Medicare.gov. Web page: Macular degeneration tests & treatment. Retrieved Jan. 31, 2025, from https://www.medicare.gov/coverage/macular-degeneration-tests-treatment

⁸ National Eye Institute. Web page: 8 Things You Can Do Right Now to Protect Your Vision. Retrieved Feb. 27, 2025, from https://www.nei.nih.gov/learn-about-eye-health/healthy-vision/8-things-you-can-do-right-now-protect-your-vision

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