What Is The Medicare Coverage For Eye Care And Eyeglasses? | Medicare Plans (2023)

What Is The Medicare Coverage For Eye Care And Eyeglasses? | Medicare Plans (1)
Kelly Blackwell

Certified Senior Advisor (CSA)®

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Kelly Blackwell

Certified Senior Advisor (CSA)®

Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.

Does Medicare Cover Vision And Glasses?

Original Medicare does not cover routine vision exams or glasses, but Part B (medical insurance) helps cover certain vision-related services if you have eye disease or injury.

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Medicare Advantage (MA) Plans, an alternative to Original Medicare, provide the same coverage as Part B, plus more. Most MA plans offer some coverage for routine eye exams and corrective lenses.

Part B vision care coverage is limited to medically necessary treatment for your eye problems. Some of the eye conditions covered by Part B may be a common and normal part of aging and are considered to be Medicare-covered services. MA plans include all Medicare-covered services plus some non-covered Medicare services, such as routine eye exams and financial allowances for corrective lenses.

What Vision Care Is Covered By Medicare?

Medicare Part B helps pay for these medically necessary vision-related services:

  • Cataract surgery if it’s done using lasers or traditional surgical techniques. This procedure replaces your cloudy lens, which is the source of your blurry vision, with a clear artificial lens called an intraocular lens (“inside the eye”).
  • Corrective lenses if you have cataract surgery – either one pair of eyeglasses with standard frames or one set of contact lenses from a supplier who is enrolled in Medicare.
  • Glaucoma screening test once every 12 months if you are at risk for glaucoma, which is increased pressure within the eyeball that adversely impacts your sight over time. Risk factors for glaucoma are:
    • Diabetes
    • A family history of glaucoma
    • If you are African American and aged 50 or older
    • If you are Hispanic and aged 65 or older
  • Yearly eye exam for diabetic retinopathy if you have diabetes. Retinopathy is a disease of the retina, the back part of your eyeball that interacts with your optic nerve to form a visual image. This exam must be done by an eye doctor who is legally allowed to do the exam in your state. Treatments may include medications, laser treatments, and surgery.
  • If you have age-related macular degeneration (AMD), Part B may cover certain diagnostic tests and treatment of eye diseases and conditions. The macula is the small central portion of your retina, and as it wears down, it causes loss of vision. Treatment may include medications, laser treatments, and vision aids.

Medicare Advantage plans provide the same coverage as Part B does for medically necessary vision care and some coverage for routine eye exams and corrective lenses.

Which Medicare Plans Are Best If You Need Vision Care?

Medicare Advantage Plans are best if you need vision care. MA plans cover all services that Original Medicare Part B does, plus help with routine eye exams and corrective lenses.

According to the Kaiser Family Foundation, 98% of individual Medicare Advantage Plans and 96% of Special Needs Plans (SNPs) available in the U.S. in 2022 offer some vision benefits. You generally must choose in-network providers and may need to obtain referrals and prior authorization.

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Details about vision care benefits you can receive and how much you pay are outlined in each plan’s Evidence of Coverage (EOC) or Summary of Benefits documents. Some plans offer additional vision care coverage for an additional monthly premium.

Here is a comparison chart of five MA insurance companies, all HMO plans, to give you an idea of what non-Medicare vision coverage may be available to you in your area (derived from each plan’s 2022 EOC or Summary of Benefits docs):

Medicare Advantage Plan ProviderAdditional Vision Benefit
AetnaRoutine exams covered; $90 reimbursement allowance for lenses every year.
Blue Cross Blue Shield/AnthemRoutine exams covered; Optional supplemental tiered packages are available for a monthly premium. $100 to $200 allowance for lenses every year.
HumanaRoutine exams covered; $100 allowance for lenses every year.
Kaiser PermanenteRoutine exams covered; $200 allowance for eyewear every year; Optional pkg with higher monthly premium: $400 allowance for eyewear every year.
UnitedHealthcareRoutine exams covered; $200 allowance for lenses (standard eyeglasses OR contacts) every year.

You can search for plans on the Medicare website. If you anticipate the need for vision care and corrective lenses, it’s a good idea to check with your eye care provider to see if they are in-network with the plan you choose.

How Much Does Vision Care Cost With Medicare?

Vision care costs depend on what your needs are and what type of Medicare insurance you have.

With Original Medicare, you pay 100% for eye exams for eyeglasses or contact lenses. If you receive vision care that is medically necessary, Part B coverage kicks in and you pay 20% of the Medicare-approved amount for doctor’s services after you satisfy your annual Part B deductible ($233 for 2022). If the service is in a hospital outpatient setting, you also pay a copayment. Your total out-of-pocket costs will depend on:

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  • Other insurance you may have
  • How much your doctor charges
  • Whether or not your doctor accepts Medicare assignments
  • The type and place you get your test, item, or service

Talk with your provider to find out more about your out-of-pocket costs with Original Medicare.

If you have a MA plan, vision care costs vary depending on your plan. All MA plans offer the same Medicare-covered, medically necessary benefits as Part B. Still, you typically must receive care from in-network providers, and your copay/coinsurance structure may be different.

Some MA plans have a $0 monthly premium (although you still pay your Part B monthly premium of $170.10 for 2022) for vision benefits. Some MA plans offer supplemental vision care coverage for a monthly premium ranging from about $10 to $70. Most MA plans with vision care have an allowance that you can apply toward the purchase of either eyeglasses or contact lenses. Depending on the plan, this allowance can be used once every 12 or 24 months and ranges from $100 to $200. Any other costs related to corrective lenses are your responsibility.

Whether you have Original Medicare or a MA plan, medically necessary vision care is considered a Medicare-covered benefit. You are eligible to receive services from approved providers, and you may be responsible for a portion of the costs in the form of a copay or coinsurance.

If your vision care needs are considered to be non-Medicare-covered, such as routine exams and corrective lenses, MA plans typically offer some benefits to decrease your out-of-pocket expenses. Of note, your out-of-pocket costs for these services do not go toward your maximum out-of-pocket limit for your medical coverage.

Is An Ophthalmologist Covered By Medicare?

As a specialist in eye and vision care, an ophthalmologist diagnoses and treats eye diseases, provides medical and surgical interventions, and prescribes and fits corrective lenses. Medicare will help pay for ophthalmologist services in cases of medical and surgical concerns related to the eyes. Original Medicare will not pay for routine eye exams or corrective lenses whether you receive them from an ophthalmologist or optometrist.

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MA plans with vision benefits will help pay for in-network ophthalmologist services. You may be required to obtain a referral or prior authorization and may incur a specialist copay and/or coinsurance for exams or surgical procedures. Contact your plan, discuss your coverage with your vision care provider, or review the EOC or Summary of Benefits for details to determine your benefits and what you have to pay.

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FAQs

What type of vision coverage is covered by Medicare? ›

Medicare Part A covers vision care only when the vision condition is considered a medical problem — as in a medical emergency or traumatic injury when the beneficiary must be admitted to the hospital. Medicare Part A does not cover routine vision exams and eye refractions.

Are eyeglass prescriptions covered by Medicare? ›

Generally, Original Medicare (Parts A & B) will not help pay for prescription sunglasses, contact lenses or eyeglasses. However, eyeglasses or other corrective lenses may be covered in cases where they are deemed “medically necessary,” such as after cataract surgery.

Does Medicare Part A or B cover vision? ›

Original Medicare Parts A and B do not cover vision care, except in certain circumstances. For example, Part B partially covers eye exams if you're at higher risk for eye complications such as glaucoma. Medicare also covers some medically necessary eye surgeries, such as cataract removal.

How many pairs of glasses does Medicare cover? ›

Corrective lenses include one pair of eyeglasses with standard frames or one set of contact lenses. The amount you must pay for health care or prescriptions before Original Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your other insurance begins to pay.

Does Medicare cover eyeglasses for seniors? ›

Medicare Part B does not pay for routine vision screening, glasses, and contact lenses. In some circumstances, such as macular degeneration and cataracts, Medicare does pay for testing and treatment. Several charitable organizations and professional societies can help older adults obtain free or low cost vision care.

Does Medicare pay for an eye exam once a year? ›

Medicare doesn't cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. You pay 100% for eye exams for eyeglasses or contact lenses.

How Much Does Medicare pay for cataract surgery in 2022? ›

Original Medicare covers 80% of the cost of cataract surgery, and patients are responsible for paying the remaining 20% (either out-of-pocket or with supplemental insurance) after meeting their yearly Part B deductible. Medicare Advantage plans, however, may require a copay.

Does Medicare pay for laser cataract surgery? ›

Medicare covers standard cataract surgery if it's done using traditional surgical techniques or using lasers. The procedure must be deemed medically necessary and is typically covered under Part B (medical insurance) as an outpatient procedure.

Does Medicare pay for cataracts surgery? ›

Medicare covers cataract surgery that involves intraocular lens implants, which are small clear disks that help your eyes focus. Although Medicare covers basic lens implants, it does not cover more advanced implants. If your provider recommends more advanced lens implants, you may have to pay some or all of the cost.

Are optometrists covered by Medicare? ›

Anyone with a current Medicare card is eligible for the Medicare subsidy for eye tests provided by optometrists. If your optometrist bulk bills the government directly on your behalf, and don't charge additional fees over the rebate amount (such as for more advanced testing), you won't have to pay anything.

How often can I have an eye test with Medicare? ›

Routine eye exam and eyeglasses once every 24 months

All beneficiaries are eligible for a routine eye exam which checks the health of the eyes and tests for an eyeglass prescription.

What does Medicare Part C pay for? ›

Medicare Part C covers the inpatient care typically covered by Medicare Part A. If you are a Medicare Part C subscriber and are admitted to the hospital, your Medicare Advantage plan must cover a semi-private room, general nursing care, meals, hospital supplies, and medications administered as part of inpatient care.

Does Medicare cover eye exams for cataracts? ›

Routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma.

Does AARP Medicare Advantage cover eyeglasses? ›

En español | No. Medicare doesn't cover eyeglasses, contact lenses or eye exams to determine your prescriptions. However, you'll find one exception: Medicare provides limited coverage for glasses or contact lenses after cataract surgery.

Do you get a free pair of glasses after cataract surgery? ›

Medicare will pay for one pair of post-cataract surgery glasses per lifetime per eye after cataract surgery.

Does AARP Medicare supplement plan g cover eye exams? ›

En español | Technically, no. Medicare doesn't cover routine eye exams, eyeglasses or contact lenses, nor does it cover exams to determine prescriptions. However, if you're in certain high-risk groups, it does cover eye exams to check for specific conditions.

Is an ophthalmologist covered by medical insurance or vision? ›

An ophthalmologist can prescribe vision correcting aids as well as take care of your eye's healthcare needs for cataracts, diabetic complications, macular degeneration and more. If you're still asking “are ophthalmologists covered by medical insurance?”, rest assured, they are covered by your health insurance.

Does Medicare cover multifocal lens for cataract surgery? ›

What are the exclusions? Though Medicare will cover both laser and traditional cataract surgeries, they do not yet cover New Technology Intraocular Lenses (NTIOLS). For instance, Medicare may not cover you if you need multifocal or toric lenses, though they will cover monofocal lenses.

What is the difference between an eye exam and a refraction? ›

A refraction is an eye exam that measures a person's prescription for eyeglasses or contact lenses. Normal vision occurs when light is focused directly on the retina rather than in front or behind it.

Does Medicare cover laser eye surgery? ›

LASIK surgery isn't usually done to prevent blindness and isn't categorized as medically necessary. It is an elective procedure done to improve vision, which can alternatively be corrected with eyeglasses or contact lenses. For that reason, it's not covered by Medicare.

Does Medicare cover yearly mammograms? ›

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. covers: A baseline mammogram once in your lifetime (if you're a woman between ages 35-39). Screening mammograms once every 12 months (if you're a woman age 40 or older).

Are optometrists covered by Medicare? ›

Anyone with a current Medicare card is eligible for the Medicare subsidy for eye tests provided by optometrists. If your optometrist bulk bills the government directly on your behalf, and don't charge additional fees over the rebate amount (such as for more advanced testing), you won't have to pay anything.

What is the difference between an eye exam and a refraction? ›

A refraction is an eye exam that measures a person's prescription for eyeglasses or contact lenses. Normal vision occurs when light is focused directly on the retina rather than in front or behind it.

Does Medicare pay for cataract eye exam? ›

Routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma.

Does Medicare Plan G cover vision? ›

Additionally, Medicare Supplement Plan G does not cover benefits for routine dental, vision, hearing, or prescription drug services. Medigap Plan G only covers the benefits that Original Medicare will cover.

How many eye tests Does Medicare cover per year? ›

Anyone holding a current Medicare card can have: One comprehensive eye test every three years (f you are under 65-years-old). One comprehensive eye test every year if you're 65 or older.

How many times can I see an optometrist under Medicare? ›

1) How often am I covered for a free eye test? Anyone with a current Medicare card can claim a rebate on a regular eye examination. If you are under 65 years of age, this is now once every 3 years. Over 65-year-olds can claim once a year.

How Much Does Medicare pay for cataract surgery in 2022? ›

Original Medicare covers 80% of the cost of cataract surgery, and patients are responsible for paying the remaining 20% (either out-of-pocket or with supplemental insurance) after meeting their yearly Part B deductible. Medicare Advantage plans, however, may require a copay.

Why does Medicare not pay for refraction? ›

The charges for a refraction are covered by some insurances but not all. For example, Medicare does not cover refractions because they consider it part of a “routine” exam and Medicare doesn't cover most “routine” procedures - only health-related procedures.

Why is refraction not covered? ›

The Cost of a Refraction

Medicare does not cover refractions because the test is considered to be a part of a routine exam and not a medical need. Medicare does not cover most routine procedures, but rather health-related vision expenses.

What is the average cost of cataract surgery with Medicare? ›

Using 2021 claims data, the U.S. Centers for Medicare & Medicaid Services (CMS) put Medicare's national average cost of cataract surgery at $1,587 when performed at an ambulatory surgical center. That includes doctor and facility fees of $548 and $1,039, respectively.

What type of cataract lens Does Medicare pay for? ›

Medicare covers cataract surgery that involves intraocular lens implants, which are small clear disks that help your eyes focus. Although Medicare covers basic lens implants, it does not cover more advanced implants. If your provider recommends more advanced lens implants, you may have to pay some or all of the cost.

Do you get a free pair of glasses after cataract surgery? ›

Medicare will pay for one pair of post-cataract surgery glasses per lifetime per eye after cataract surgery.

How much does Plan G cost a month? ›

How much does Medicare Plan G cost? Medicare Plan G costs between $120 and $364 per month in 2022 for a 65-year-old. You'll see a range of prices for Medicare supplement policies because each insurance company uses a different pricing method for plans.

Is Plan F better than Plan G? ›

Although the plans have several similarities, there is one key difference between Plan F and Plan G: With Medicare Plan F, you're getting the plan with the most coverage available. In addition to the above coverage, Plan F also covers Medicare Part B deductible payments. Plan G does not.

What Plan G does not cover? ›

Medigap Plan G does not cover dental care, or other services excluded from Original Medicare coverage like cosmetic procedures or acupuncture. Some Medicare Advantage policies may cover these services. Like Medigap, Medicare Advantage is private insurance.

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