Does Medicare Cover Diabetic Eye Exams? 

Today in the United States, there are approximately 9.6 million people with diabetic retinopathy – a common microvascular complication caused by diabetes. Diabetic retinopathy is often caused by high levels of blood sugar over a prolonged period in patients with untreated diabetes. 

Some of the most common symptoms include:

• Floaters in your vision
• Blurred vision
• Dark spots or empty areas in your vision
• Loss of vision

As the leading cause of blindness for adults in this country, diabetic eye exams can be crucial screenings. While diabetic retinopathy is the most common cause of vision loss for diabetics, they also have a higher risk of developing other serious eye conditions like cataracts or open-angle glaucoma. 

If you’ve been diagnosed with diabetes or pre-diabetes, your health care provider has probably suggested that you have your eyes tested frequently, but does Medicare cover these exams?

Does Medicare cover diabetic eye exams?

Original Medicare Part B (medical insurance) covers the following eye exams at least once a year for people who have been diagnosed with diabetes: 

Diabetic Retinopathy Screening
Uncontrolled, high blood sugar levels can cause damage to the walls of the small blood vessels of the eye, causing them to thicken, leak, clot, become blocked, or grow microaneurysms. In some instances, the retina loses its blood supply and grows new defective vessels that can bleed and cause hemorrhages and vision impairment.  

To test for diabetic retinopathy, your ophthalmologist dilates your pupils and views the retina using specialized lenses and a light called a slit lamp. In more serious cases, another test called a fluorescein angiography may be used.

Medicare Part B covers one annual eye exam for diabetic retinopathy if you have diabetes. Part B pays 80 percent of the final, Medicare-approved cost if you have the test done by an eye doctor who can do it in your state legally and accepts Medicare assignment. After you’ve covered your Part B deductible for the year, you pay the remaining 20 percent. 

If you have this test done in a hospital outpatient clinic, you may also be responsible for paying a co-payment to the facility. 

Glaucoma Screenings 

Original Medicare Part B covers one annual glaucoma screening if you’re at high risk of developing glaucoma. Your Medicare-affiliated physician may certify that you’re at risk if you meet at least one of the following eligibility criteria:

• You’re diabetic
• You have a family history of glaucoma
• You’re African American and over 50 years old
• You’re Hispanic and over 65

What will you pay for diabetic eye exams with Medicare?

Original Medicare Part B pays 80 percent of the cost for your glaucoma screening if it’s done by a licensed health care provider who accepts Medicare assignment. You pay the balance of the charge after meeting your annual deductible. You may also have to pay a copayment to the hospital outpatient clinic where you have your test done.

Original Medicare Part B also covers 80 percent of the final approved cost for testing and treatment with injected drugs for macular degeneration. Medicare Part B pays its share of the cost for testing and treatment, and you pay the balance after meeting your deductible. 

If you have a Medicare Advantage (MA)plan, your provider must cover the same benefits that Original Medicare Parts A and B do. Today, most MA plans also provide extra benefits like routine vision, hearing, and dental care, so your plan may offer more coverage for eye exams whether they’re related to diabetes.

Depending on the type of Medicare Advantage coverage you have, your plan may use in-network providers, so check your policy before making appointments for eye exams.