Medicare Part B generally does not cover routine eye exams for eyeglasses or contact lenses. However, it does cover certain diagnostic and preventive eye exams when you have specific medical conditions.
In this guide, you'll learn:
What types of eye exams Medicare Part B covers.
The conditions that qualify for Medicare coverage.
The frequency of covered eye exams.
What costs to expect.
Medicare Part B focuses on medically necessary eye exams.
Diagnostic Exams: Medicare covers eye exams when you have medical conditions like:
Glaucoma
Cataracts
Diabetic retinopathy
Age-related macular degeneration (AMD)
Preventive Exams: Medicare also covers yearly glaucoma tests for high-risk individuals and yearly eye exams for people with diabetes.
Glaucoma Tests: Once every 12 months for high-risk individuals.
Diabetic Retinopathy Exams: Once every 12 months for people with diabetes.
AMD Exams: As often as medically necessary when you have AMD.
Cataract Surgery Exams: Medicare covers one exam before cataract surgery to measure the power of the intraocular lens.
You must have a diagnosed medical condition affecting your eyes, such as those listed above.
The eye exam must be medically necessary to diagnose or treat that condition.
Even with Medicare coverage, you might have some out-of-pocket costs:
Part B Deductible: You'll need to meet your annual Part B deductible before Medicare starts paying.
Coinsurance: You'll typically pay 20% of the Medicare-approved amount for the eye exam.
Excess Charges: If your doctor doesn't accept Medicare assignment, you may have to pay excess charges.
Medicare covers specific eye exams when medically necessary for certain conditions, but not routine vision care. Understanding these coverages can help you manage your eye health and related costs. For more insight into how this concept interacts with others, see our detailed guide on Medicare Advantage Plans, which further explores additional vision benefits that some Medicare Advantage plans offer, and their implications in greater depth.
Medicare's coverage of eye exams is dependent on medical necessity, not a set frequency for everyone.
If you have diabetes, you can get a diabetic retinopathy exam once a year.
If you are at high risk for glaucoma, you can get a glaucoma test once a year.
If you have age-related macular degeneration (AMD), you can get exams as often as medically necessary.
For other eye conditions, Medicare covers diagnostic exams when they are medically necessary.
Routine vision exams for glasses or contacts are not covered.
The cost of a Medicare-covered eye exam for seniors depends on several factors:
Part B Deductible: You must meet your annual Part B deductible before Medicare starts paying.
Coinsurance: After meeting the deductible, you typically pay 20% of the Medicare-approved amount for the exam.
Doctor's Acceptance of Assignment: If your doctor accepts Medicare assignment, they agree to Medicare's approved amount. If not, you may have to pay excess charges.
Therefore, the out of pocket cost will vary depending on the above factors.
Medicare does pay for certain specific eye exams once per year, but not a general routine eye exam.
Yearly glaucoma tests for high-risk individuals.
Yearly diabetic retinopathy exams for people with diabetes.
Medicare does not cover routine vision exams for glasses or contact lenses.
Medicare Part B generally does not cover:
Routine eye exams for eyeglasses or contact lenses.
Refraction tests (used to determine your prescription for eyeglasses or contact lenses).
Essentially any eye exam that is for the purpose of getting glasses or contacts is not covered.