Does Medicare Pay for Eye Exams?

No, Original Medicare (Medicare Part A and Part B) does not cover routine vision care. This includes standard eye exams, eyeglasses and contact lenses. There are certain exceptions made for beneficiaries who have glaucoma or diabetes.

However, some Medicare Advantage plans (Medicare Part C) may cover routine eye exams.

Some Medicare Advantage plans may also include coverage for prescription eyeglasses and other routine vision care services.

Eye doctor gives her patient an eye exam

What type of vision care is covered by Medicare?

Original Medicare (Part A and Part B) may cover certain vision exams if the exam is considered medically necessary by your primary care physician.

Below are some examples of the types of vision exams that may be covered by Original Medicare.

  • Annual eye exams for people with diabetes
    Medicare Part B may cover one yearly exam for diabetic retinopathy, as long as the exam is conducted by an eye doctor who has been approved by your state.

    You must be enrolled in Medicare Part B and have diabetes in order for Medicare to cover your annual eye exam.

  • Cataract tests
    Medicare may cover cataract tests and cataract surgery if the procedure is considered medically necessary by your doctor. If it is an outpatient procedure, you must have Medicare Part B to qualify for coverage. If it is an inpatient procedure, it should be covered by your Medicare Part A benefits.

  • Glaucoma tests
    Medicare Part B may pay for annual glaucoma tests for patients who are considered to be high risk for developing glaucoma.

  • Macular degeneration exam
    Medicare Part B may cover your macular degeneration eye exam if it is considered medically necessary by your doctor.

For medically necessary vision services that are covered under Medicare Part B, you must first meet your Part B deductible ($198 per year in 2020) before Medicare will begin paying its share of the costs for your eye exams.

After you meet your Medicare Part B deductible, you typically pay 20 percent of the Medicare approved amount of the costs, and Medicare pays the remaining 80 percent.

Some Medicare Advantage plans may cover eye exams

Medicare Advantage plans are sold by private insurance companies and combine the benefits covered by Medicare Part A and Part B into one plan.

Some Medicare Advantage plans include benefits that aren’t offered by Original Medicare, such as vision care coverage.

If your Medicare Advantage plan covers vision care, it may provide benefits that include corrective lenses, frames, routine eye exams and other benefits.

Some of the other additional benefits that may be offered by some Medicare Advantage plans can include:

How often can I have an eye test with Medicare?

Medicare will typically cover one eye exam per year if you suffer from glaucoma or diabetes and otherwise qualify for coverage.

Original Medicare does not cover routine eye exams. Some Medicare Advantage plans may cover routine eye exams once a year or more frequently, depending on your plan. Speak with your plan carrier for more details on the vision coverage and benefits available in your plan.

Does Medicare Part G cover eye exams?

Medicare Supplement Insurance, or Medigap, does not offer coverage for eye exams or other eye care services or products. 

One popular Medigap plan, Medicare Supplement Plan G, offers coverage for a number of different out-of-pocket Medicare costs. Plan G, like other Medigap plans, does not however cover eye exams.

Medigap plans, sold by private insurance companies, provide coverage for some of the out-of-pocket costs associated with Original Medicare such as deductibles, coinsurance and copayments.

A Medigap plan may be used to help supplement coverage for an eye exam that is covered by Medicare, though.

For example, if your eye exam is covered by Medicare Part B because you suffer from diabetes, you will typically pay a 20% coinsurance cost for your exam (after meeting your annual Part B deductible). 

A Medigap plan that covers Part B coinsurance costs, such as Medigap Plan G, can help pay this cost for you.

Does Medicare Part D cover eye exams?

Medicare Part D provides coverage exclusively for prescription drugs. While these plans may provide coverage for medications prescribed for eye infections, diseases or injuries, Part D plans do not cover the cost of eye exams. 

Most Medicare Advantage plans cover prescription drugs. 

How do I enroll in a Medicare Advantage plan that covers eye exams?

A licensed insurance agent can help you find Medicare Advantage plans in your area that may offer vision coverage. You can compare plans, and you may be able to sign up for a Medicare plan that covers eye exams.

Explore Medicare Advantage plan benefits in your area

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Or call 1-800-557-6059 (TTY: 711) 24/7 to speak with a licensed insurance agent.