Does Medicare Cover Eye Care? 

Most people experience vision changes as they get older. Some start to notice they have trouble reading fine print without “readers.” Others say that the TV screen is blurry, or nighttime driving isn’t fun anymore. Some people experience vision loss that disrupts their everyday activities. 

As you age, you should be getting regular eye exams so your physician can find possible eye disease in the early stages and provide treatment options. Your ophthalmologist should be looking for any of the following common conditions that commonly affect senior’s vision:

• Age-related macular degeneration  
• Cataracts 
• Diabetic retinopathy 
• Dry eyes 
• Glaucoma 

If you’re enrolled in Medicare, you might have coverage for some vision care. It depends on the type of plan you have, what test you’re getting, and your medical needs. Here’s a better look at how Medicare covers vision and eye care. 

Does Medicare cover eye care? 

Original Medicare Part B (outpatient medical insurance) doesn’t cover routine eye exams, eyeglasses, or contact lenses, and you must pay 100 percent of the cost for this care.

However, Medicare Part B doescover the following vision care services for beneficiaries who are eligible for the benefits:

• Screenings for diabetic retinopathy one time per year for those who have diabetes if the exams are performed by a physician who is legally permitted to do so in your state. 
• One annual glaucoma screening if you’re at high risk due to diabetes, a family history of glaucoma, being African American and 50 or older, or being Hispanic and 65 or older. Also, the eye doctor must be lawfully permitted to perform glaucoma tests in your state.
• Macular degeneration screening and treatment if you’ve been diagnosed with this condition. 

For the above-listed screenings, Medicare Part B pays 80 percent of the approved cost of the physician’s fee, and you pay 20 percent after paying your annual Part B deductible. You are also responsible for paying a copayment if the testing is done in a hospital outpatient setting. 

Original Medicare Part B also covers cataract surgery to remove a cataract and replace it with an intraocular lens. To qualify for coverage, your physician must certify that it’s a medically necessary procedure. Also, the physician caring for you and the medical facility where the procedure is done must accept Medicare assignment. 

Medicare Part B pays 80 percent of the cost of cataract surgery, and you pay 20 percent after paying your Part B deductible for the current year. 

Medicare Advantage (Part C) 

All Medicare Advantage (MA) plans cover all the benefits that Original Medicare Parts A and B do, and most MA plans include extra benefits like routine dental, hearing, and vision care.

If your plan includes coverage for routine eye care services and supplies, you probably have the following benefits:

• Routine eye refractions (exams to check vision)
• Eyeglasses and contact lenses (there may be limits on the number of pairs per year) 
• Cataract surgery and corrective lenses 
• Glaucoma screenings 
• Macular degeneration screening and treatment 
• Diabetic retinopathy screening and treatment 

Because every Medicare Advantage plan has coverage options, you should check your printed or online policy or contact a plan representative for detailed information about your vision care benefits. Also, your plan may require that you use in-network physicians to be eligible for coverage.