Original Medicare doesn’t pay for routine eye exams unless you’re known to be in a high-risk group for eye disease — although some Medicare Advantage plans do include vision coverage.
Because some potentially serious eye conditions aren’t apparent to the patient in their early stages, when treatment could prevent or reduce loss of vision, it makes sense for anyone eligible for Medicare to find a way to get periodic eye exams.
Most Americans ages 60 and up should have an eye exam every year or two, as should people in high-risk groups, such as 40-and-older African Americans and individuals with high blood pressure, diabetes or a family history of glaucoma, according to the National Eye Institute.
When does Medicare cover eye exams?
Medicare Part B (part of Original Medicare) covers an eye exam only when a patient has diabetes, which can cause diabetic retinopathy, or is deemed at risk for glaucoma or macular degeneration. Any of these diseases can cause blindness.
Does Medicare cover eyeglasses or contact lenses?
Original Medicare doesn’t cover corrective lenses in most cases. However, Medicare Part B may cover one pair of eyeglasses or contact lenses if needed after cataract surgery.
Can Medigap or Medicare Advantage cover vision care?
Medigap, also known as Medicare supplemental insurance, doesn’t cover routine eye exams for people who haven’t been identified as high risk.
Some Medicare Advantage Plans, also known as Medicare Part C and provided through private insurers, may cover eye exams even when you’re not in a high-risk group. Contact the private insurers that offer Medicare Advantage Plans to ask about their vision care coverage, which might include eyeglasses and contact lenses as well as eye exams.
But since a routine eye exam isn’t a major medical expense, choosing Medicare Advantage just for that coverage may not always be the best value.
How else can you get eye exam coverage?
Private vision insurance, provided by many employers and also available to individuals, is a way to spread out over the year some of the costs of eye exams, eyeglasses and contacts, and possibly save money. You might be able to get insurance for vision care for about $20 per month.
For some people, it may make sense to simply pay for their eye exam out of pocket. The average cost of a dilated eye exam, including a vision test, glaucoma check and other assessments, is about $200 for a new patient or $128 for an established patient.
For people with low incomes, Medicaid in most states covers routine eye exams. Some states have copays, but they’re usually small.
The American Academy of Ophthalmology’s EyeCare America program offers eligible people ages 65 and up an eye exam by a volunteer ophthalmologist, often with no out-of-pocket cost. You don’t need a low income to qualify for this program.