Does Medicare Cover Vision Benefits?

 

If you’re a Medicare beneficiary looking for Medicare coverage of routine eye exams or glasses, don’t look to Original Medicare, Part A and Part B, for these benefits in most situations. Original Medicare doesn’t cover routine vision care.

Medicare Part A typically covers vision care only in circumstances where something happens to the eye(s) that requires inpatient hospitalization.

Medicare Part B covers part of the cost for one pair of glasses or one pair of contact lenses following cataract surgery where a new lens was implanted to replace your damaged lens. Other than that, Part B does offer some vision benefits, but it’s hardly comprehensive as far as vision care is covered. Some Medicare Advantage plans offer routine vision benefits.

The Medicare Part C program (Medicare Advantage) offers an alternative way of receiving your Original Medicare, Part A and Part B, benefits. Available from private insurance companies that contract with Medicare, Medicare Advantage plans include all Part A and Part B benefits except hospice care, which is still covered under Medicare Part A.

In some cases, Medicare might cover certain vision-related items or services if an illness or injury resulted in eye problems. If you’re in this category, contact your Medicare plan (if you’re enrolled in Medicare Part C) or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week; TTY users call 1-877-486-2048.

Medicare typically pays 80% of Medicare-approved amounts for vision-related items and services  covered by Medicare Part B such as those listed below, while  you pay 20%. For items such as glasses, contact lenses, artificial lenses, and artificial eyes, you must use a Medicare-approved supplier to get Medicare coverage.

Vision screening and risk factors

Although Original Medicare doesn’t cover routine vision care, Medicare Part B covers one preventive vision screening per year for those at high risk for glaucoma. According to the Centers for Medicare & Medicaid Services, African-Americans aged 50 and older, Hispanic Americans aged 65 and older, people with diabetes, and people with a family history of glaucoma are at high risk for the disease. An eye doctor who’s legally permitted by your state must perform the exam.

Eyeglasses, intraocular lenses and contact lenses

Certain Medicare Advantage plans cover eyeglasses, intraocular (artificial) lenses, and contact lenses, but Original Medicare generally doesn’t include these vision benefits, except when following cataract surgery. You must use a Medicare-approved supplier.

Cataract surgery

Medicare covers cataract surgery and related costs, including the procedure to restore your vision by replacing the damaged lens with an artificial one. Make sure you know if you’re an inpatient or outpatient because what you pay may be different. Medicare covers the cost for one pair of eyeglasses, contact lenses, or intraocular lenses that may be necessary to correct your vision following cataract surgery.

Eye prostheses (artificial eyes)

Medicare covers eye prostheses (artificial eyes) for beneficiaries without an eye or who have eye shrinkage because of birth defect, vision trauma, or surgery. You’re also covered for polishing and resurfacing of your artificial eye. Medicare will pay for a replacement once every five years.

If you are enrolled in Medicare Part B, you are covered. You’ll pay 20% of the Medicare-approved amount for the eye prostheses, and the Part B deductible applies. You must use a Medicare-approved supplier.

Routine eye refraction tests

This is simply a routine vision screening. Original Medicare doesn’t offer this vision benefit, although some Medicare Advantage plans may.

Macular degeneration diagnosis and treatment

According to the National Institutes of Health, this disabling vision disease is associated with aging. Often gradually, vision is reduced in the center of the visual field, making it difficult to identify faces even though your vision allows you to see around the edges. Medicare Part B (and, by extension, Medicare Advantage) vision benefits may cover the costs of diagnosis and treatment, including certain prescription drugs used to treat macular degeneration.

Finding Medicare coverage for routine vision services

Medicare Advantage plans may offer benefits such as routine vision coverage, but such additional benefits vary among plans, so you may want to research plans carefully. You might find a Medicare Advantage plan that covers prescription drugs, vision services, and other items and services that are important to you, at a cost you can easily afford. To find a plan in your area, just enter your zip code in the box on this page.

To learn about Medicare plans you may be eligible for, you can:

  • Contact the Medicare plan directly.
  • Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
  • Contact a licensed insurance agency such as Medicare Consumer Guide’s parent company, eHealth.
    • Call eHealth's licensed insurance agents at 888-391-2659, TTY users 711. We are available Mon - Fri, 8am - 8pm ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
    • Or enter your zip code where requested on this page to see quote.

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