Using Medicare for Vision Coverage

Medicare can be tricky to navigate, especially when it comes to eye care. Many plans don’t cover routine eye exams, but others may. Some plans cover additional treatment for eye issues, while others don’t. And a lot of what’s covered can depend on your individual medical history. Wondering if your own Medicare plan pays for routine vision exams, as well as surgeries for vision problems such as cataracts and glaucoma? Read on to find out.

Does Medicare Cover Vision Exams?
In most cases, Original Medicare does not cover routine eye exams. That means you are responsible for 100 percent of the bill for eye exams for glasses and contacts. However, Original Medicare will cover vision exams in the following situations: 

• Diabetes: If you have diabetes, Medicare Part B will cover an annual eye exam for diabetic retinopathy. You’ll be responsible for 20 percent of Medicare-approved charges after your Part B deductible has been met. 
• Glaucoma: If you’re at risk for glaucoma, Medicare covers a routine eye exam given by a state-authorized doctor. You’re considered high risk for glaucoma if one or more of the following applies:
  • You have a family history of glaucoma.
  • You have diabetes.
  • You are an African American and age 50 or more. 
  • You are a Hispanic American and age 65 or more. 

You are responsible for 20 percent of the Medicare-approved amount, and the Part B deductible applies. You are also responsible for a copayment if your eye exam takes place in a hospital outpatient facility, such as a surgery center, emergency room, or observation unit. 

• Injury: If your eye is hurt in an accident or you suffer a non-chronic condition like a detached retina, Medicare covers diagnosis as well as treatment. Again, after your Part B deductible has been met, you are responsible for 20 percent. 
• Potential Vision Problems: If your doctor suspects you have a serious eye condition and needs to conduct an eye exam to provide a diagnosis, Medicare will cover the cost. This still holds even if the visit determines that you don’t have a vision issue. After your Part B deductible has been met, you are responsible for 20 percent of Medicare-approved charges. 

What Treatments for Cataracts and Glaucoma Does Medicare Cover?
Speaking of potential vision problems, vision issues such as cataracts and glaucoma may require additional care. In these cases, Medicare covers the following treatments:

• Cataract Surgery: Medicare covers surgery to have a cataract removed and an intraocular lens implanted. It also covers eyeglasses or contacts if they’re needed as a result of the cataract surgery. Medicare covers a basic pair of prescription eyeglasses or contacts; if medically necessary, Medicare will cover customized eyeglasses or contacts. Note that Medicare will only cover glasses and contacts from a Medicare-approved supplier.
• Glaucoma Surgery: Surgeries, laser therapies and eye drops to treat glaucoma are covered by Medicare. In most scenarios, Part B covers 80 percent of the costs after your deductible has been met.

Which Medicare Plans Cover Routine Vision Care?
Many Medicare Advantage Plans cover vision, as well as dental and hearing. Often called “Part C” or “MA Plans,” Medicare Advantage Plans include Part A (Hospital Insurance), Part B (Medical Insurance), and in some cases, Part D (Prescription Drug Plan).  

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Medicare can be tricky to navigate, especially when it comes to eye care. Many plans don’t cover routine eye exams, but others may. Some plans cover additional treatment for eye issues, while others don’t. And a lot of what’s covered can depend on your individual medical history. Wondering if your own Medicare plan pays for routine vision exams, as well as surgeries for vision problems such as cataracts and glaucoma? Read on to find out.

Does Medicare Cover Vision Exams?
In most cases, Original Medicare does not cover routine eye exams. That means you are responsible for 100 percent of the bill for eye exams for glasses and contacts. However, Original Medicare will cover vision exams in the following situations: 

• Diabetes: If you have diabetes, Medicare Part B will cover an annual eye exam for diabetic retinopathy. You’ll be responsible for 20 percent of Medicare-approved charges after your Part B deductible has been met. 
• Glaucoma: If you’re at risk for glaucoma, Medicare covers a routine eye exam given by a state-authorized doctor. You’re considered high risk for glaucoma if one or more of the following applies:
  • You have a family history of glaucoma.
  • You have diabetes.
  • You are an African American and age 50 or more. 
  • You are a Hispanic American and age 65 or more. 

You are responsible for 20 percent of the Medicare-approved amount, and the Part B deductible applies. You are also responsible for a copayment if your eye exam takes place in a hospital outpatient facility, such as a surgery center, emergency room, or observation unit. 

• Injury: If your eye is hurt in an accident or you suffer a non-chronic condition like a detached retina, Medicare covers diagnosis as well as treatment. Again, after your Part B deductible has been met, you are responsible for 20 percent. 
• Potential Vision Problems: If your doctor suspects you have a serious eye condition and needs to conduct an eye exam to provide a diagnosis, Medicare will cover the cost. This still holds even if the visit determines that you don’t have a vision issue. After your Part B deductible has been met, you are responsible for 20 percent of Medicare-approved charges. 

What Treatments for Cataracts and Glaucoma Does Medicare Cover?
Speaking of potential vision problems, vision issues such as cataracts and glaucoma may require additional care. In these cases, Medicare covers the following treatments:

• Cataract Surgery: Medicare covers surgery to have a cataract removed and an intraocular lens implanted. It also covers eyeglasses or contacts if they’re needed as a result of the cataract surgery. Medicare covers a basic pair of prescription eyeglasses or contacts; if medically necessary, Medicare will cover customized eyeglasses or contacts. Note that Medicare will only cover glasses and contacts from a Medicare-approved supplier.
• Glaucoma Surgery: Surgeries, laser therapies and eye drops to treat glaucoma are covered by Medicare. In most scenarios, Part B covers 80 percent of the costs after your deductible has been met.

Which Medicare Plans Cover Routine Vision Care?
Many Medicare Advantage Plans cover vision, as well as dental and hearing. Often called “Part C” or “MA Plans,” Medicare Advantage Plans include Part A (Hospital Insurance), Part B (Medical Insurance), and in some cases, Part D (Prescription Drug Plan).  

Want to receive more helpful tips about Medicare? Sign up for our newsletter here.

 Approved YM04012111

Return to: Medicare Advantage