Does Medicare Cover Eye Exams?

Are you confused about what’s covered by Medicare? Dial (800) 950-0608 to speak with one of our available agents, or use our contact form to let us know if you’re interested in coverage for eye exams.

Routine eye exams are important as you age.

The risk of developing serious vision problems – including macular degeneration, cataracts (requiring cataract surgery), and glaucoma – increases as Americans grow older. The National Eye Institute recommends regular comprehensive dilated eye exams for adults age 50 and older.

While some groups of people, including those with diabetes or a family history of eye disease, are considered higher risk for developing eye disease than others, vision problems are not always the result of genetics or symptoms of a separate medical condition. Some common eye issues can be resolved or prevented with regular care, and routine eye exams are an important part of health maintenance for most seniors.

Does Medicare cover eye exams?

Traditional Medicare will cover routine eye exams from medical professionals only when certain conditions are met. If a senior is at high risk for developing eye disease or vision problems because they have diabetes, have a family history of glaucoma, or are a part of an ethnic group defined as high risk,  they will receive partial coverage for routine eye exams related to those conditions.

For seniors who do not meet the above requirements, Medicare Part B does not cover routine eye exams. If you are concerned with monitoring your vision as you age and seeking out routine vision tests as a form of preventative healthcare, you will need to pay for testing and exam costs completely out of pocket.

However, there are other options for seniors without diabetes or a history of glaucoma who want to get coverage for eye exams. Optional Medicare Part C, or Medicare Advantage plans, often cover routine eye exams and other vision related health services. Enrolling in a Medicare Advantage plan that offers Medicare vision coverage is an excellent way for seniors who want to monitor their vision as they age – or who already wear glasses or contacts – to ensure they get the coverage they need.

Want to make sure you’re getting the vision coverage you need through Medicare? Our agents are available to answer your Medicare questions at (800) 950-0608.

Do I need vision coverage through Medicare Advantage?

• I have diabetes or a family history of glaucoma:
  If you have been diagnosed with diabetes, or if you’ve already confirmed with your doctor that you are considered high risk for developing glaucoma, you may find that traditional Medicare already offers the coverage you need to receive adequate preventative care and treatment. However, even if you meet any of these conditions and need visual aids like glasses or contacts, you will have to pay 100% of costs related to those appliances. So, considering Medicare Advantage may still be the right option for you if you need eyeglasses or contact lenses.
• I do not have diabetes or a family history of glaucoma, but I wear glasses or contacts:
  Original Medicare does not cover any costs related to glasses or contact lenses, including eye care related to glasses or contacts. If you need these vision aiding appliances, a Medicare Advantage plan that offers vision benefits may be the right choice for you. Many Medicare Advantage plans offer coverage for eye exams related to glasses and contact lenses, and for the devices themselves.
• I do not have diabetes or a family history of glaucoma, and I do not currently need glasses or contacts:
  Eye disease and blindness are not considered inevitable parts of aging, but statistics do show older Americans experience eye and vision problems more frequently as they continue to age. Vision loss often occurs gradually and proper healthcare, including routine eye care, can help seniors keep their eyes as healthy as possible and prevent issues that may develop over time. Vision benefits are important for seniors, even if they have never experienced problems with their eyes or eyesight, and exploring Medicare Advantage plans may give seniors who are concerned about eye health and vision loss more peace of mind than Medicare Part A and B can give alone.

Are there other benefits to Medicare Advantage besides vision coverage?

Medicare Advantage plans must cover everything that Medicare Part A and Part B cover and generally offer additional benefits besides that, including eye care coverage. When you enroll in a Medicare Advantage plan, you may have access to vision coverage, hearing coverage, and other benefits you wouldn’t get with traditional Medicare.

If you have questions about Medicare Advantage or want to learn more about Medicare in general, give us a call at (800) 950-0608. Our agents are available to guide you through the complicated process of choosing the right plan for you.