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What Does Medicare Cover Regarding an Eye Exam?

Medicare is the government program that provides health care services for the elderly, and for eligible individuals with disabilities. The program provides a comprehensive set of benefits to senior citizens, but it does not provide coverage for all medical and health care services. For example, Medicare does not typically cover the cost of eye exams, but some conditions of the eye and some vision services are reimbursable under the program.

  1. Eye Exam

    • Medicare does not cover the cost of routine eye exams, but the program does provide reimbursement for certain screenings, such as glaucoma screenings. Medicare pays for a glaucoma screening once every 12 months, but only for patients who are at high risk of this eye disease. Those high-risk patients include people with diabetes and those with a family history of glaucoma. All other Medicare patients must pay for their own eye exams, including the cost of the glaucoma screening. Medicare also reimburses the cost of screening and treatment for some patients with age-related macular degeneration. If your ophthalmologist has diagnosed you with this condition, talk to the billing office about your coverage and possible Medicare reimbursement.

    Glasses and Contact Lenses

    • Medicare does not typically pay for the cost of eyeglasses and contact lenses. If you have Medicare, discuss the costs of prescription eye wear with your vision provider. Many vision service providers are willing to work with their patients to get them the lowest possible prices, especially if those patients do not have insurance to cover the costs. If you have a Medicare supplement or Medicare Advantage plan, that plan may pick up some of the costs associated with prescription eyeglasses, sunglasses and contact lenses as well.

    Cataract Surgery

    • If you have had cataract surgery that includes the implantation of an intraocular lens, Medicare will pay for the glasses and contact lenses prescribed by your ophthalmologist following that surgery. Only one pair of eyeglasses is covered by Medicare, and the prescription for those glasses must be signed by the treating physician.

    Medicare Advantage Plans

    • If you choose a Medicare Advantage plan instead of traditional Medicare, that plan may provide additional coverage, including coverage for eye exams, glasses and contact lenses, dental services and more. Medicare Advantage plans are offered by private insurance companies, and each plan has its own list of covered services and restrictions. You can find information about Medicare Advantage programs in your area by contacting the insurance companies directly, or by visiting the Medicare.gov website for more information.

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