Medicare Coverage for Seniors - Eye Exams, Glasses and the Vision Benefits Many People Miss

Good vision matters more with age, yet many people on Medicare aren't sure what their coverage includes for eye exams and glasses.

The answer depends on whether you have Original Medicare or a Medicare Advantage plan, and on why you need eye care in the first place. This guide explains Medicare coverage for seniors when it comes to vision, where to find an eye exam near you that accepts your coverage, what else you may need beyond Parts A and B, and how to get Medicare help.

Original Medicare and Routine Eye Care

Original Medicare (Parts A and B) generally doesn't cover routine eye exams for glasses or contact lenses, and it doesn't pay for eyeglasses or contacts in most cases.

That surprises many people, because Medicare does cover a wide range of eye care when it's tied to a medical condition. Knowing the difference can save you money.

Eye Care Medicare Part B Does Cover

• Glasses or contacts after cataract surgery. After cataract surgery that implants an intraocular lens, Part B helps pay for one pair of eyeglasses with standard frames or one set of contact lenses. You typically pay 20% of the Medicare-approved amount after the Part B deductible, and you must buy them from a Medicare-enrolled supplier.
• Diabetic eye exams. People with diabetes can get a yearly exam to check for diabetic retinopathy.
• Glaucoma tests. Covered once every 12 months for people at high risk.
• Macular degeneration. Certain tests and treatments for age-related macular degeneration.
• Cataract surgery itself.

Medicare Advantage and Vision Benefits

Medicare Advantage plans cover everything Original Medicare does, and many add routine vision benefits, such as a yearly eye exam and an allowance toward glasses or contacts. Benefits vary by plan, so compare:

• Whether routine eye exams are covered, and how often
• The yearly dollar allowance for frames, lenses or contacts
• Which eye doctors and optical stores are in network
• Whether the plan also includes dental and hearing benefits

Finding an Eye Exam and Glasses Near You

1. Check your plan's provider directory, or call the number on your member card, to find vision providers near you that are in network.
2. Ask the office directly whether they accept Medicare, your Medicare Advantage plan or your vision plan before booking.
3. Know which type of visit you need. A medical eye exam for a condition such as glaucoma may be billed to Medicare, while a routine exam for new glasses may not be.
4. Compare eyewear prices. Optical stores, warehouse clubs and online retailers can differ widely, especially for progressive lenses.

I Have Medicare A and B. What Else Do I Need?

Many seniors add coverage to fill gaps that Parts A and B leave open:

• Prescription drug coverage through a Part D plan or a Medicare Advantage plan with drug coverage
• A Medicare Supplement (Medigap) policy to help with deductibles and coinsurance under Original Medicare
• Or a Medicare Advantage plan, which often bundles drug, vision, dental and hearing benefits
• Standalone vision insurance if you keep Original Medicare and want routine eye care covered

There isn't one plan that covers everything, so the best choice depends on your doctors, prescriptions and budget. Medicare Open Enrollment, from October 15 to December 7, is the main time each year to switch plans for better vision benefits.

Medicare at 70 and Beyond

If you're 70 and still working with employer coverage, you may have delayed Part B. You can usually enroll later without a penalty through a Special Enrollment Period, but check the timing carefully. Once you're on Medicare, review your coverage each fall, since plan benefits, including vision allowances, can change every year.

Other Medicare Services for Seniors

Medicare covers more than many people realize. Recommended vaccines are covered, as our article on the shingles vaccine under Medicare explains, and some mobility equipment is covered under Part B, as our guide to Medicare coverage for walkers describes.

Where to Get Medicare Help

• Call 1-800-MEDICARE (1-800-633-4227) with coverage questions.
• Contact your State Health Insurance Assistance Program (SHIP) for free, unbiased one-on-one counseling.
• Ask about Extra Help and Medicare Savings Programs if your income is limited.

Frequently Asked Questions

Does Medicare pay for glasses?

Original Medicare generally doesn't, except for one pair after cataract surgery with an implanted lens. Many Medicare Advantage plans include an eyewear allowance.

Does Medicare cover eye exams?

Original Medicare covers some medically necessary eye exams and tests but not routine exams for glasses. Many Medicare Advantage plans cover a yearly routine exam.

When can I change to a plan with vision coverage?

During Medicare Open Enrollment, October 15 to December 7, with coverage starting January 1.

This article is general information, not insurance advice. Coverage and costs vary by plan, so confirm details with Medicare or your plan.