Does Medicare Cover Vision?

Does Medicare Cover Vision?

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Original Medicare does not provide routine eye care but covers services related to eye conditions or surgery. Medicare Advantage policies often cover routine eye care such as exams, glasses and contact lenses, on top of standard Medicare benefits.

When it comes to vision care, Medicare Advantage plans generally offer lower out-of-pocket costs and more coverage than Original Medicare. If you are new to Medicare, need routine vision care and are considering your options, we recommend starting with Medicare Advantage plans.

Does Original Medicare cover routine vision care?

No, Medicare does not cover routine vision exams or corrective eyewear. You pay 100% for routine eye care, including exams, eyeglasses and contact lenses.

Does Original Medicare cover eye care for medical needs?

Although routine vision services are not covered, Medicare provides eye care benefits for certain other medical needs.

Eyewear after cataract surgery

After cataract surgery, Medicare covers you for one pair of glasses or contact lenses provided by a participating Medicare supplier.

Prosthetic eyes

Medicare covers a prosthetic or artificial eye and follow-up polishing and resurfacing of the eye twice per year. Prosthetics must be ordered by a doctor and provided by a Medicare-participating supplier.

Diabetes

Medicare allows an annual eye exam for diabetic retinopathy if you have diabetes. The exam must be done by an eye doctor who’s licensed to do the test in your state.

Glaucoma

Medicare covers an annual glaucoma test if you’re at high risk for the disease. You’re considered high risk if one or more of these applies to you:

  • You have diabetes.
  • You have a family history of glaucoma.
  • You’re African American and age 50 or older.
  • You’re Hispanic and age 65 or older.

An eye doctor who is licensed to do this test in your state must perform or supervise the screening.

Macular degeneration

Diagnostic tests for age-related macular degeneration are covered if your doctor determines you have the condition. An ophthalmologist or optometrist will perform the eye exam.

How much does Medicare pay for vision care?

Medicare pays 80% of the Medicare-approved cost of vision services, procedures and supplies such as eyewear. If Original Medicare is your only insurance, you'll pay the remaining 20% after meeting your deductible. When vision services are performed in an outpatient hospital setting, you'll also pay a separate hospital copay. The copay amount varies but will never exceed the Medicare Part A deductible amount, which is $1,556 for 2022.

Medicare-participating providers and suppliers agree to accept payment that is typically lower than their regular fee. When you use a participating provider, the amount you owe is based on that lower amount. This reduces your final payment and saves you money.

How do Medigap plans cover vision care?

Medigap plans cover costs left over after Medicare pays. Once you meet the Medicare deductible, you pay 20% of the Medicare-approved amount for vision services. Depending on the policy, Medigap plans cover some or all of that 20%.

Medigap plans pay your remaining balance (the 20%) in full, with just a few exceptions. Plan K pays only 50% of your cost, and Plan L pays 75%. Plan N pays the 20% and then charges you a copay.

If Medicare rejects a claim, Medigap does not cover any of the cost and you are responsible for all charges.

The table below shows what you would pay for vision services performed in a medical office after meeting your Medicare deductible. In this scenario, Medicare approved a charge of $100, of which it paid 80%, or $80, to the participating provider.

With Medigap, your portion of the remaining $20 would be as follows:

Medigap plan
Your cost
Plan A$0
Plan B$0
Plan C$0
Plan D$0
Plan F$0
Plan G$0
Plan K50% coinsurance, or $10
Plan L25% coinsurance, or $5
Plan M$0
Plan N$0-$20 copay

Does Medicare Advantage cover vision?

Medicare Advantage plans are required to provide at least the same vision benefits as Original Medicare. This includes eyewear after cataract surgery, prosthetics and care related to diabetics, glaucoma and macular degeneration. Many Medicare Advantage policies add benefits not covered by Original Medicare, like eyewear and routine vision exams. Costs and coverage vary, so it's important to check plan documents to find a policy that suits your needs and budget.

Best Medicare Advantage options for vision care

Of the vision plans we reviewed, three stood out as top options based on factors such as add-on benefits and coverage limits.

Blue Cross Blue Shield: Highest eyewear benefit amount
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AARP/UHC: Home eyewear delivery option
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Humana: Highest eyewear benefit amount
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We focused our review on Medicare HMO plans for consistency in costs and coverage levels. Like a medical HMO, a vision HMO plan usually requires either preauthorization for services or a referral by your family doctor, or both. In most cases, you also need to use in-network vision providers.

The plans we reviewed all had copays of $0 for almost every benefit or service. But eyewear coverage varies widely and helps some plans to stand out among the others.

Medicare Advantage plan
Upside
Downside
CMS star rating
AARP/UnitedHealthcare (UHC)Eyeglass lenses covered in full. Potential home eyewear deliveryEyewear benefits only every two years4
AetnaEyewear benefit can be used for any provider$115 annual eyewear benefit low compared to other plans4
Blue Cross Blue ShieldEyewear coverage totals $600 every two yearsNo downside compared to other plans4
Cigna$250 annual eyewear benefit$20 copay per Medicare-covered services other than glaucoma and retinopathy screening4.5
HumanaEyewear coverage totals $600 every two yearsNo downside compared to other plans4
Kaiser PermanenteAdded eyewear allowance with purchase of Advantage Plus packageStandard biannual eyewear benefit of $40 very low; Advantage Plus doesn't bring it to the level of the top plans5

What if I need vision care that Medicare does not cover?

If you need care that your Medicare plan does not cover, the National Eye Institute website has a list of helpful resources. Visit the institute's Get Help Paying for Eye Care page for more information.

You also may want to consider a private vision plan or discount program. Private plans often offer benefit levels ranging from routine to specialty care, so you can tailor coverage to meet your needs. When reviewing plans, watch for coverage limits, network restrictions and out-of-pocket expenses like deductibles and copays.

Frequently asked questions

How often will Medicare pay for eye exams?

Medicare does not pay for routine eye exams for most people. However, it does cover annual checkups if you've been diagnosed with diabetes or glaucoma.

Does Medicare cover vision and dental?

Generally, Original Medicare does not cover routine vision and dental care. But many Medicare Advantage plans do offer those benefits.

Which Medicare Advantage plan has the best routine vision benefit?

Humana and Blue Shield each stood out with their total eyewear benefits of $600 every two years, which is the highest amount offered among the plans we reviewed. Some vision services, such as routine eye exams, are covered in full by all the plans we researched.

Methodology

Our policy recommendations are based on selections that offer good vision benefits and overall value. Plans such as Humana and Blue Cross Blue Shield offer higher levels of eyewear coverage, so both are solid options where available.

Medicare quotes and plan details were sourced from AARP/UnitedHealthcare, Aetna, Blue Cross Blue Shield, Cigna, Humana and Kaiser Permanente. Additional sources include Medicare.gov, CMS.gov and the National Eye Institute website.

Editorial Note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.