Will Medicare cover eye exams and eyeglasses? Here’s what you need to know!

As we age, it’s critical to keep our eyes healthy even if we don’t currently wear glasses. Original Medicare does not pay for eye exams, including glasses. But many Medicare Advantage offer plans that cover regular eye check-ups and other services.

Important reminders

• Eye exams detect severe health conditions like high blood pressure and diabetes.
• The American Academy of Ophthalmology recommends adults over the age of 65 have their vision checked at least once a year.
• Remember to ask providers which tests and screenings they cover under your Medicare plan.

What does Medicare pay for vision care?

Original Medicare consists of two parts: Part A (hospital insurance) and Part B (medical insurance). Neither Part A nor Part B of Original Medicare cover the cost of glasses, contact lenses, or routine eye exams. Part B may pay for certain preventive services, including an annual eye exam, but only in certain cases. Under normal circumstances, Medicare Original pays $0 for vision care.

Medicare Advantage (Part C) is an alternative option for getting Medicare coverage. These plans may offer added coverage for routine eye care and the cost of eyeglasses or contact lenses. If you are already a Medicare Advantage plan member, check with your plan provider and verify your coverage. Speaking to a licensed insurance agent is also a reliable source. Attain Health’s smart advisor provides an unbiased and personalized assessment of your Medicare coverage needs. And includes all your current health conditions and medications. With the information it provides, you can make an informed decision about whether or not to switch to a Medicare Advantage plan.

Does Medicare cover eye exams?

If you have Original Medicare, it doesn’t cover a comprehensive routine eye exam. If a provider states it’s medically necessary to treat or prevent an illness or injury, Original Medicare may grant an exception for the following.

• Diabetes
• Age-related muscular degeneration
• Glaucoma
• Cataracts

The costs fall under Part B and covers diagnostic tests like glaucoma screenings and dilated eye exams related to other health problems. Remember, members pay 20% of the bill and Medicare covers 80% of it.

Medicare Advantage (MA) plans typically cover routine eye exams. MA plans are offered by private insurance companies that have a contract with Medicare. Members continue paying their Medicare Part B monthly premium to Medicare. And they also pay a monthly premium to the private insurer for their MA plan. (Many MA plans have low or no monthly premium. Premiums vary by the plan and where a person lives.)

What is Medicare coverage for eyeglasses?

Members with Original Medicare pay out of pocket for glasses or contact lenses since it does not have vision as a benefit. A member can purchase a standalone vision plan to help cover the cost of eye care that includes glasses or contact lenses.

Medicare Advantage plans often include with their eye care, glasses or contact lenses. If you have an MA plan, check with your plan provider to what they cover.

Does Medicare pay for eyeglasses for diabetics?

If you have diabetes, it’s vital to get your eyes checked at least once a year. After medical necessity is established, Original Medicare Part B helps cover the costs of eye exams and eyeglasses for diabetics and also outpatient procedures. The member pays 20% of the Medicare-approved amount for a doctor’s visit. Part A helps cover the cost for certain vision services and supplies related to a hospital stay. The member is responsible for the Part A deductible.

MA plans must offer all the benefits of Original Medicare. But they have the freedom to offer added coverage that goes beyond what Original Medicare offers. These MA plans may include routine eye exams that address concerns outside of the Part B annual exam for diabetes. If you’re a member of an MA plan and experiencing vision issues related to diabetes, contact your plan for more detailed information.

Who accepts Medicare for eyeglasses?

There are several optometrists, ophthalmologists, and vision centers that accept Medicare. You can find national and regional retailers accepting Medicare when you check in for an eye exam or get new glasses. You can also ask for a list of accepted insurance plans from your chosen establishment or optometrist. Some of these places also allow for online ordering and contactless pick-up or delivery of glasses.

Many Medicare Advantage plans with eye care require use of a specific provider network.

Look for optical centers that take Medicare

There are a few national optical centers that accept Medicare. The easiest way to check whether the provider of your choice accepts Medicare is to check its website. Look to see if they list Medicare as an accepted insurance plan. Then call and verify they accept your insurance. During your call be sure to check if the center meets your needs and what you’ll have to pay for services.

Where do I find a Medicare eye doctor list?

You can find lists of Medicare eye doctors by visiting the website of the American Academy of Ophthalmology. You can also use the Medicare Plan Finder tool to find doctors who accept Medicare. When using it, be sure to select “eye care” as your type of provider. You can also contact the Medicare helpline at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Bottom line

Even if you’re happy with the condition of your eyes, it’s important to stay on top of your eye health. Regular eye exams can help catch problems early before they cause severe damage. If your Medicare plan does not include routine eye exams and glasses or contact lenses, you can buy a standalone plan for vision care. With a bit of research, you can find the right coverage you need. Just be sure you know what your current Medicare plan does and doesn’t include.