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What is the Medicare coverage for eye care and eyeglasses?

Generally, Medicare coverage does not extend to routine eyeglasses or contact lenses. However, following cataract surgery with an intraocular lens, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses provided by an ophthalmologist.

Post-cataract services provided by an optometrist may be covered, if the optometrist is licensed to provide this service in your state, and:

  • Medicare will pay only for standard frames.
  • Lenses are covered even if you had the surgery before you had Medicare.
  • Both eye lenses may be covered even if you had your cataract surgery on one eye only.

A prescription order signed by your doctor (ophthalmologist or optometrist) must be on file with the supplier. Suppliers must be enrolled in Medicare and must meet strict standards to qualify for a Medicare supplier number. Medicare won't pay your claim if your supplier doesn't have a number, even if your supplier is a large chain or department store that sells more than just durable medical equipment (DME).

After each cataract surgery with an intraocular lens, you pay 20% of Medicare-approved amounts for one pair of eyeglasses or contact lenses.

Medicare will only reimburse or pay for the standard eyeglass frame amount. You pay an additional cost for upgraded frames.

For more information about Medicare eye care, you may call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week.

Note: Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment. If the supplier is a participating supplier, it must accept assignment. If the supplier is enrolled in Medicare but isn't "participating," it has the option to accept assignment.

If the supplier isn't enrolled in Medicare, Medicare won't pay your claim.

Glaucoma screening

For people with Medicare at high risk for glaucoma, once every 12 months Medicare covers glaucoma screening. This includes people with diabetes, a family history of glaucoma, or African-Americans who are age 50 and older. The screening must be done or supervised by an eye doctor who is legally allowed to do this service in your state.

You pay 20% of Medicare-approved amounts.

Routine eye exams

Routine eye exams are not covered by Medicare, although some preventive eye tests and screenings, such as glaucoma screening and treatment of macular degeneration, are covered.

You pay 100% out-of-pocket for routine eye exams.

Treatment of macular degeneration

For some patients with age-related macular degeneration (called ocular photodynamic therapy with verteporfin), this condition is covered by Medicare. You pay 20% of Medicare-approved amounts for diagnosis and treatment of diseases and conditions of the eye.

Eye prostheses

Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defect, trauma or surgical removal. Polishing and resurfacing is covered twice per year.

One enlargement or reduction of the prosthesis is covered without documentation. Additional enlargements or reductions are rarely medically necessary and are covered only when information in the medical record supports the medical necessity. This information must be available to the DMERC on request.

Replacement of an ocular prosthesis is governed by the five-year reasonable useful lifetime rule. Replacement of a prosthesis or prosthetic component before five years is covered if the prosthesis is irreparably damaged, lost or stolen.

You pay 20% of Medicare-approved amounts.

Eye refractions

Medicare does not cover eye refractions. You pay 100% out-of-pocket for eye refractions.

Eyeglasses and contact lenses

Generally, eyeglasses or contact lenses are not covered by Medicare. However, following cataract surgery with an intraocular lens, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses provided by an ophthalmologist. Services provided by an optometrist may be also covered, if the optometrist is licensed to provide this service in your state.

About Medicare eyeglasses coverage:

  • Only standard frames are covered.
  • Lenses are covered even if you had the surgery before you had Medicare.
  • Payment may be made for lenses for both eyes even though cataract surgery involved only one eye.

You pay 20% of Medicare-approved amounts for one pair of eyeglasses or contact lenses after each cataract surgery with an intraocular lens. You pay any additional cost for upgraded frames.

Medicare has neither reviewed nor endorsed this information.

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Medicare has neither reviewed nor endorsed this information.