What Is the Medicare Coverage for Eye Care and Eyeglasses?
Generally, Original Medicare does not cover routine eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses; one pair of eyeglasses or one set of contact 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.
- Eyeglasses and contact 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 one set of contact lenses, after the Part B deductible, if applicable.
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.
Medicare Part B covers a glaucoma screening test once every 12 months for people at high risk for glaucoma. This includes people with diabetes, a family history of glaucoma, African Americans who are age 50 or older, and Hispanic Americans who are age 65 or 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, and the Part B deductible applies.
Routine eye exams
Routine eye exams are not covered by Medicare, including eye refractions. However, some preventive eye tests and screenings, such as glaucoma screening and treatment of macular degeneration, are covered.
You pay 100% out-of-pocket under Original Medicare for routine eye exams.
Treatment of macular degeneration
Medicare Part B will cover certain diagnostic tests and treatment of diseases and conditions of the eye, which include treatment with certain injected drugs. Some people with age-related macular degeneration (AMD) are covered by Medicare. You would be responsible for 20% of Medicare-approved amounts for diagnosis and treatment of diseases and conditions of the eye after the Part B deductible is applied.
Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defect, trauma or surgical removal. Medicare covers polishing and of the artificial eye, and typically covers replacement every five years.
You pay 20% of Medicare-approved amounts after the Part B deductible is applied.
Medicare Advantage plans and vision coverage
While Original Medicare coverage of routine vision care is limited, some Medicare Advantage plans may include additional vision benefits. Medicare Advantage plans are required to provide at least the same level of coverage as Medicare Part A and Part B, but many plans also cover additional benefits that go beyond Original Medicare, which may include routine dental or eye care.
Under a Medicare Advantage plan, vision benefits may include:
- Preventive eye exams covered under Original Medicare
- Routine eye exams
- Eyeglasses (frames and lenses)
- Contact lenses
Keep in mind that the specific benefits may vary, depending on the Medicare Advantage plans available in your service area. For more information, check with the individual health plan you’re considering. If you’d like help finding a Medicare Advantage plan that includes vision benefits, you can visit Medicare.gov or call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week (TTY users, call 1-877-486-2048. You can also contact eHealth to speak with a licensed insurance agent about your Medicare plan options.
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