What Parts of Medicare Cover Eye Exams?
Although Original Medicare doesn’t cover eye exams, other parts of Medicare may be able to help pick up the cost for medically necessary services for vision conditions related to diabetes, glaucoma or macular degeneration.
Medicare Part A
Medicare Part A (hospital insurance) doesn’t cover routine eye exams for eye glasses and contact lenses, so you’d have to pay 100 percent of the cost. However, Medicare Part A can cover medically necessary vision care under the specific condition that the patient has a vision problem or experienced a traumatic injury or other type of emergency that required hospitalization.
Medicare Part B
Medicare Part B (medical insurance) doesn’t cover routine eye exams or refractions, so you’d have to pay 100 percent of the costs. In some cases, Medicare Part B can cover 80 percent of the cost of eye exams for diabetic retinopathy once a year if you are diagnosed with diabetes.
The exam must be performed by a state-certified eye doctor, and you’d have to pay 20 percent of the remaining Medicare-approved amount for services and a copayment in a hospital outpatient setting. Additionally, Medicare Part B can cover annual eye exams for individuals with glaucoma and other high-risk patients with diabetes who may be prone to vision problems requiring medically necessary care. Part B can also cover cataract surgery as well as the placement of an artificial lens, along with vision care services such as eyeglasses with standard frames, post-cataract surgery.
Some Medicare Advantage Plans (Part C) may offer additional benefits that are not typically covered by Medicare, such as vision, hearing, or dental. It’s best to contact your Medicare Advantage provider for the most up-to-date information on out-of-pocket costs and coverage. Under Medicare Advantage, you may receive additional benefits such as routine vision care, which includes eyeglasses and contacts.
Medigap/Medicare Supplemental Insurance
Medigap or Medicare Supplemental Insurance is additional insurance that you can purchase from a private insurer. Medigap does not cover routine dental and vision care such as eye exams, eyeglasses, or contacts. However, Medigap will help cover the cost of cataract surgery or other vision conditions. The rule of thumb is, as long as Original Medicare covers it, your Medigap plan will too. However, if Original Medicare doesn’t cover it, your Medigap plan won’t either.