How Does Medicare Cover Vision Care and Eye Exams?
How Does Medicare Cover Vision Care and Eye Exams?
Find Cheap Medicare Plans in Your Area
When it comes to vision care, Medicare Advantage plans generally offer lower costs and more coverage than Original Medicare. If you are shopping for a plan and need routine vision benefits like exams and eyewear, we recommend starting with Medicare Advantage options.
Which Medicare plans cover vision care and eye exams?
Original Medicare, Medigap and Medicare Advantage all provide vision benefits, but coverage varies by plan type and insurer. Of the three options, you'll get the most coverage with a Medicare Advantage plan.
|Routine eye exam|
|Glasses or contacts|
|Glaucoma eye exam|
|Macular degeneration exam|
|Prosthetic eyes and maintenance|
Does Medicare cover eye exams?
While Medicare doesn't cover routine vision exams, you can get eye checkups for certain medical concerns.
Medicare will pay for regular tests if you're at risk for — or have been diagnosed with — diabetes, glaucoma or macular degeneration. If you don't have these conditions and are on Original Medicare, you'll pay the full price for a routine eye exam, which is between $170 and $200, on average.
Medicare allows an annual eye exam for diabetic retinopathy if you have diabetes.
Medicare covers an annual glaucoma test if you’re at high risk for the disease:
- Family history of glaucoma
- African American (age 50+)
- Hispanic (age 65+)
Diagnostic eye exams for age-related macular degeneration are covered if your doctor finds — or suspects — you have the disease.
Medicare also covers vision care for people who've received a prosthetic eye or had cataract surgery.
Medicare limits how often you can use these benefits, so be sure to follow the guidelines to get the most coverage.
Eyewear after cataract surgery
After cataract surgery, Medicare covers you for one pair of glasses or contact lenses provided by a participating Medicare supplier.
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.
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. For example, if your glaucoma test costs $80, your portion will be $16.
When you receive vision care in an outpatient hospital, you'll also pay a separate hospital copay. The copay amount varies but will never exceed the Medicare Part A deductible amount, which is $1,600 for 2023.
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 does Medicare Advantage cover vision?
Medicare Advantage plans provide at least the same vision coverage as Original Medicare, but many add benefits like routine eye exams and eyewear.
At a minimum, Medicare Advantage plans provide vision benefits equal to those offered by Original Medicare. This includes eyewear after cataract surgery, prosthetics and care related to diabetes, glaucoma and macular degeneration. Many Medicare Advantage policies add benefits not covered by Original Medicare, like eyewear and regular vision exams. Costs and coverage vary, so it's important to check plan documents to find a policy that suits your needs and budget.
Medicare Advantage vision coverage at a glance
- 98% of plans offer added vision benefits
- Over 50% of plans require prior approval
- Most policies have coverage limits of $100-$200 per year
- Eyewear is generally covered every one or two years
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.
Like a medical HMO, a vision HMO plan usually requires either prior approval by your insurer or a referral by your family doctor, or both. In most cases, you also need to use in-network vision providers.
Plans we reviewed all had no copays for most routine eye care services. But coverage for glasses, contacts and other eyewear varies widely, which means that some plans stand out.
Medicare Advantage plan
|AARP Medicare Advantage Plan 1||Eyeglass lenses covered in full, potential home eyewear delivery||Low maximum benefit of $100 per year|
|Aetna Medicare Select||$250 annual eyewear benefit||No downside compared to other plans|
|Blue Cross Medicare Advantage Value||Unlimited number of contacts up to maximum dollar amount||Low benefit maximum|
|Cigna Preferred Medicare||$200 annual eyewear benefit||Up to $20 copay per Medicare-covered service other than glaucoma and retinopathy screening|
|Humana Gold Plus||$200 annual eyewear benefit||Up to $20 copay per Medicare-covered service other than glaucoma and retinopathy screening|
|Kaiser Enhanced 1 Plan||$500 eyewear benefit every two years||Nonroutine services cost more than competitors|
How do Medigap plans cover vision care?
Medigap plans are designed to pay their portion of health costs — including vision care — only if Medicare covers the charge.
If Medicare does cover the service, it will pay 80%. Depending on the policy, your Medigap plan will cover some or all of the Medicare deductible and your 20% coinsurance.
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.
For example, if Medicare approves a charge of $100 for vision services you received, Medicare would pay 80%. If you've met your Part B deductible, you would be responsible for the remaining 20%, or $20. This cost would be covered in full or in part depending on your Medigap plan.
|Plan K||50% coinsurance, or $10|
|Plan L||25% coinsurance, or $5|
|Plan N||$0-$20 copay|
Your cost after Medicare and Medigap payments
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 for free or low-cost eye care.
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
Does Medicare cover eye exams and glasses?
Medicare does not pay for routine eye exams, and glasses are covered only after cataract surgery. Many Medicare Advantage plans provide benefits for eye exams and eyewear, but coverage varies by policy.
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 dental and vision?
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?
Aetna and Kaiser Permanente stand out with total eyewear benefits of $250 per year, 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.
Our policy recommendations are based on selections that offer good vision benefits and overall value.
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.
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