When it comes to health, your eyes can certainly tell a story about your overall well-being. As you get older, that story gets more chapters — and becomes more complex.
Unfortunately, Medicare, the federal health insurance program primarily for those 65 and older, doesn’t cover all your vision care needs.
Before you head to the eye doctor for a vision check or medical eye exam, find out what might be covered and what you’ll have to pay for out of pocket.
[SEE: Do You Need Eyeglasses? Watch for these Common Signs.]
Does Medicare Cover Eye Exams?
In short, no, original Medicare does not cover routine eye exams for eyeglasses or contact lenses. Medicare also does not cover the cost of glasses or contact lenses unless you’ve just had cataract surgery.
“It’s a common frustration among Medicare beneficiaries that original Medicare (Part A and Part B) does not cover routine eye exams,” says Bob Rees, chief sales officer with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
Does Medicare Part B pay for eye exams?
Medicare Part B, the outpatient component of Medicare, does not cover everyday vision care.
“Unfortunately, while routine eye exams are preventative in nature, original Medicare Part A or Part B do not cover them,” confirms David Luna, a Phoenix-based licensed Medicare agent and president and co-founder of Connie Health, a platform that helps seniors connect with a local agent to choose a Medicare plan.
That means that if you need a new prescription for eyeglasses or contact lenses, Medicare won’t cover the cost of the exam — unless you meet certain criteria.
Medicare Part B covers field of vision tests if they are medically necessary, adds Terri Wilson, senior vice president of VSP Vision Care, a vision care health insurance company headquartered in Rancho Cordova, California.
These tests are typically used to diagnose or monitor eye health-related conditions such as glaucoma, macular degeneration or diabetic retinopathy.
Medicare’s eye exam coverage explained
Although Medicare does not cover routine vision care visits, it may cover services related to a vision problem that suggests a potential medical issue, says Dr. Yuna Rapoport, a board-certified ophthalmologist and founder and CEO of Manhattan Eye, a New York-based ophthalmology practice that treats Medicare patients.
In those cases, Rapoport explains, “Medicare covers a complete medical eye exam, which includes a slit lamp and dilated fundus exam, vision, pressure, glaucoma, cornea and macular degeneration testing.”
If you have diabetes-related vision problems, Medicare covers one annual exam by an eye doctor licensed in your state.
Medicare also covers one annual eye exam by a state-authorized eye doctor if you have a high risk for glaucoma.
These are the high-risk individuals for whom Medicare will cover annual eye care:
— People with diabetes
— People with a family history of glaucoma
— African American patients age 50 or older
— Latino patients ages 65 or older
[READ: How Often Should a Full Eye Exam Be Done?]
Does Medicare Pay for Glasses or Contacts
As with routine eye exams, original Medicare does not pay for glasses or contact lenses. This includes most eyeglasses lenses and frames and most contact lenses and contact lens fittings.
However, Medicare Part B covers one pair of eyeglasses with standard frames or a set of contact lenses after cataract surgery. Beneficiaries must pay 20% of the Medicare-approved amount after meeting the Part B deductible for these devices.
[Read: Medicare vs. Medicare Advantage: How to Choose.]
Does Medicare Advantage Cover Eye Exams and Vision Care?
Some Medicare Advantage plans (Part C) do cover routine vision care, eyeglasses and contact lenses, Wilson explains. But coverage varies by plan.
For example, some plans offer an in-network benefit, which allows a member to see any vision provider in the plan’s network, while other plans offer a direct member reimbursement benefit, which provides an annual benefit amount to use for covered eyewear.
Because of these variations, it’s important to check your vision benefits when enrolling in a Medicare Advantage plan.
Medicare vs. Medicaid: Vision Care Comparison
Medicare coverage is designed for seniors as well as individuals under age 65 with disabilities who meet certain criteria.
Medicaid, on the other hand, is a joint federal and state health insurance program designed for low-income people regardless of age. Eligibility for Medicaid depends on specific income and other criteria as set by the state where you live.
For those who qualify, Medicaid offers health insurance benefits for a variety of conditions and services. Some states, for instance, have preventive eye health programs designed for adults and may cover glaucoma or other eye disease health screenings. Like Medicare, Medicaid covers part of the cost of cataract surgery.
In all cases, benefits provided by Medicaid vary by state, so you’ll have to connect with a local agent or adviser to help you understand what’s covered by Medicaid where you live.
Navigating Vision Care Expenses
An annual vision test is always a good idea, and if you wear glasses, it’s particularly important to make sure that your prescription stays current.
Because Medicare doesn’t cover the cost of routine eye exams, you’ll have to pay for these exams out of pocket or find a supplemental insurance plan to help defray the costs.
Out-of-pocket expenses and tips for affordability
Luna notes that an eye refraction exam, which measures your corrective lens prescription, could cost around $60, but you’ll also need to account for the general patient exam. If you’re a new patient, that could cost $250. If you’re an existing patient, that’s usually a little less, an average of $155.
After your doctor finishes your exam, you may need new corrective eyeglasses or contact lenses.
“Most people pay between $100 and $150 for their prescription eyeglass frames,” Luna says.
Medicare Part A and Part B do not cover the cost of eyeglasses or contact lenses, which means those will be out-of-pocket expenses.
In total, “you’re looking at $315 out of pocket for the eye exam and a new pair of prescription glasses at the low end,” Luna adds. “The cost depends on the exam and choosing basic or upgraded frames and lenses.”
Regular Eye Exams Are Important for Overall Health
As you age, your eyes change, and your ability to see objects up close or far away often shifts. Routine eye exams or vision tests can help you preserve your vision — and your independence — longer. Some people stop being able to drive without corrective eyewear, especially at night.
Routine exams help detect early signs of:
— Glaucoma
— Cataracts
— Macular degeneration
— Diabetes-related eye issues, such as diabetic retinopathy
“Early detection and intervention can help prevent or mitigate serious vision problems,” Wilson says.
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Does Medicare Cover Eye Exams, Glasses and Vision Care? originally appeared on usnews.com
Update 02/24/25: This story was previously published at an earlier date and has been updated with new information.
