Does Medicare Pay For Eye Exams?
Teton Medicare • July 12, 2023

July 12, 2023


medicare cover eye exams, eyeglasses or contact lenses


Yes,  Medicare  pays for medically necessary eye exams for people with chronic eye conditions or diabetes.



Medicare Vision Coverage



Medicare does not cover routine eye care.  That means it offers no coverage for the general public for their corrective lenses, eyeglasses, contacts, frames, or eye exams with the eye doctor.



Medicare does, however, cover medically necessary eye exams in special cases. If you have a chronic eye condition, Medicare will help pay for your treatments.



Chronic Eye Conditions



Medicare  covers routine eye care, including medically necessary eye exams, for people with chronic eye conditions like cataracts and glaucoma. Medicare covers surgical procedures to repair the function of the eye along with surgery to remove the cataract from the eye and replace the eye’s lens with an intraocular lens. If you have had cataract surgery, Medicare will cover one pair of eyeglasses if you need them or customized lenses if medically necessary.



When you have a chronic eye condition, Medicare covers medically necessary eye exams to diagnose potential vision problems. If you are at high risk for glaucoma, Medicare will cover an annual eye exam. This is the case for people who have had diabetes, have a family history of glaucoma, are Black and older than 50 or are Hispanic American and older than 65.



Diabetes



If you have diabetes, Medicare will cover an annual eye exam to check for diabetes-related vision problems. These potential eye problems include diabetic retinopathy, which is caused by damage to the blood vessels in the back of the eye. Blood sugar fluctuation can lead to the strain, which is progressive.



Macular Degeneration



Macular degeneration, also known as age-related macular degeneration, is seen as a loss in the center of the field of vision. The retina deteriorates, causing blurred vision. Routine eye exams can help to spot the onset of macular degeneration.



Vision Coverage



medicare approved amount vision services cover routine eye exams

Because Medicare does not cover routine eye care unless you have a chronic eye condition, many people are left to purchase vision insurance as a separate policy. Vision is offered as a supplemental insurance by many major health insurance companies. You may even be able to purchase it in a bundle with dental insurance for a better value on monthly premiums. 



Supplemental vision insurance gives you coverage for frames, lenses, contacts, glasses, and regular eye exams with your eye doctor. It is important to see your eye doctor when your vision changes and as you get older, you should visit more frequently to watch out for macular degeneration and other vision impairments. 



Vision insurance comes with monthly premiums along with copayments when you visit the eye doctor. Each plan will have a different level of coverage for frames, contacts, and lenses. Most Medicare advantage plans are localized to your region.



Finding Vision Insurance



Finding any insurance can be tricky and vision insurance is no exception. You have to compare pricing and benefits for frames, lenses, and eye exams along with the monthly premiums. It’s best to find a plan that fits your budget and your eye care needs. Contact Teton Medicare for more assistance with  finding the best Medicare coverage.


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