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You may have heard Medicare doesn’t cover eye exams, but that statement’s a little misleading. The truth is your eye exam might be covered if it meets certain requirements.
- Original Medicare will pay for medical eye exams if you have an eye injury or abnormal condition.
- Medicare won’t pay for routine eye exams, vision exams, eyeglasses, or most contact lenses.
- If you have a Medicare Advantage plan, you may have vision coverage in addition to medical eye coverage.
- If Medicare Parts A or B cover your eye care, you’ll still have to pay out-of-pocket costs like your deductible and coinsurance.
What are the four different types of eye exams?
There are a few different types of eye exams, and whether or not Medicare will cover your exam depends on which of the following categories it falls into:
- A routine eye exam evaluates the overall health of your eyes. It’s also called a comprehensive eye exam. During this type of exam, your provider will check for — and possibly diagnose — eye disease or abnormalities.
- Your provider may also evaluate your need for eyeglasses (or update your current prescription, if you already wear them). While this is technically called a “refraction,” some folks refer to it as a vision exam.
- If you wear or want to wear contact lenses, you’ll need a separate contact lens exam in addition to your routine eye exam. Your provider will perform specific tests and measurements to fit you for contact lenses.
- If you have a problem with your eye, you’d have a medical eye exam — one meant to diagnose and treat an eye condition. Conditions that require a medical eye exam include an eye injury, cataracts, irritation or infection, and many more.
When Medicare pays for eye exams and glasses
Medicare only covers medical eye exams and related treatments, with a few exceptions. Since Part A is your hospital coverage, coverage would only kick in if you suffer a traumatic eye injury or emergency that requires you to be admitted to the hospital. Most of your eye care will be covered by Part B.
Eye exams Medicare Part B covers
If you need a medical eye exam (for example, you have a non-emergency eye injury, flashers and floaters, or dry eye), your exam and care are covered by Part B.
Medicare Part B also covers cataract surgery, including the specific exams leading up to it. Here’s when one of those previously mentioned exceptions appears: After cataract surgery, Medicare will cover one pair of conventional eyeglasses or conventional contact lenses after each [cataract] surgery. This is the only time Medicare will pay for eyeglasses.
Medicare Part B also covers the following eye care services:
- An annual glaucoma screening for high-risk patients. You are usually considered high risk if you have a family history of glaucoma, are an African American over age 50, are a Hispanic American over age 65, or if you have diabetes.
- An eye prosthetic (artificial eye) and certain maintenance of the prosthetic if you lose your eye due to trauma or surgical removal.
- Certain screenings, diagnostic tests, and treatments for age-related macular generation.
- Contact lenses used to treat a medical condition.
One eye exam Medicare never covers
Original Medicare doesn’t cover routine eye exams, or any type of exam related to prescribing, fitting, or changing eyeglasses. This means you’ll be responsible to pay for your yearly doctor visit to check your eyes and update your prescription. Medicare never pays for vision exams (also called refractions), even after cataract surgery.
Although Original Medicare doesn’t provide vision coverage, it doesn’t mean you’ll automatically have to pay out of pocket for eye exams and glasses or contacts. That depends on what other types of coverage you have, if any.
- If you have a Medicare Supplement plan, you’ll still have to pay out of pocket for routine eye exams. This is because Medicare Supplement plans are designed to help you cover the costs of Original Medicare, not add coverage for items or services Original Medicare doesn’t cover.
- If you have a Medicare Advantage plan, you may have vision coverage. Some plans provide coverage for a yearly exam, plus an allowable dollar amount to put toward glasses or contacts. Check with your specific plan to see what your specific coverage entails.
RELATED: Find out if there are Medicare Advantage plans in your area.
How to get your eye exams covered by Medicare
If you know you have vision needs that are difficult to pay for on your own, you may want to search for a Medicare Advantage plan that includes vision coverage beyond what Original Medicare offers. If you find one you like, you can join the plan when you’re newly eligible for Medicare at age 65, or during Medicare Open Enrollment (October 15 to December 7).
If you already have a Medicare Advantage plan but want to switch to one with better vision coverage, you can do that during Medicare Advantage Open Enrollment (January 1 to March 31).
Still not sure about your Medicare coverage for eye exams or any other health-care needs? Check with a licensed Medicare expert first at 844-259-6504 to weigh your options.
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