Does Medicare Cover Eye Exams

Yearly eye exam

All people with  Medicare Part B and/or is diabetic  covers a yearly eye exam for diabetic retinopathy by an eye doctor who’s legally allowed to do the test in your state.

Medicare does not cover routine eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. You pay 20% of the Medicare approved amount for the doctor’s services, and the Part B  deductible applies. As a hospital outpatient, you may pay a copayment.

Medicare Part B vision benefits

Medicare Part B is medical insurance and covers some vision care, but not routine vision exams.

Medicare Covers:

  • Covers some preventive and diagnostic eye exams
  • Covers yearly glaucoma screenings for people who are at high risk and
  • Covers cataract surgery. Medicare covers the cost of the artificial lens you would need to replace the lens that affected by cataracts, as well as the cost for vision correction products, such as glasses with standard frames, following cataract surgery. You pay the 20% Medicare coinsurance for the amount approved by Medicare, subject to your annual Medicare deductible.
  • Vision benefits covers eye prostheses for patients with absence or shrinkage of the eye due to birth defect, trauma, or surgical removal.
  • It also covers the polishing and resurfacing of vision prostheses twice per year under its vision benefits, as well as one enlargement or reduction in size of prostheses without documentation.
  • Covers ocular photodynamic therapy with verteporfin, which is a treatment for patients with macular degeneration, a vision problem associated with age.

Medicare Part C (Advantage Plans) vision benefits

 

Medicate Advantage plans are offered by private, Medicare-approved insurers. All private insurers must offer at least the same benefits as Original Medicare (except hospice care, which Medicare Part A covers), but they may include other benefits, such as routine vision, routine dental, and Medicare prescription drug coverage. Routine vision benefits  are available through a Medicare Advantage plan, your premiums could be higher than those charged by Medicare Advantage plans that do not offer routine vision benefits.

Some Medicare Advantage plans include full coverage for routine vision exams, vision correction products, and other vision  care. Review the specific Medicare Advantage plan’s vision benefits to be sure.