Does Medicare Cover Vision Services?

With over 90% of Medicare beneficiaries needing eyeglasses or corrective lenses, vision services is one of the most important benefit categories for seniors. Despite this clear demand, Medicare’s coverage of vision services can be quite minimal, depending on the type of plan that you have (i.e., Original Medicare, Original Medicare with a Medicare Supplement (Medigap) plan, or Medicare Advantage). In this article, we explore Medicare’s vision benefits, including how these vary based on the type of Medicare plan in which you are enrolled.

Does Original Medicare Cover Vision Services?

Original, fee-for-service Medicare (Part A and Part B) typically offers very little in the way of coverage for vision benefits. While Original Medicare may cover some eye care services that fall under the category of chronic conditions such as cataracts and glaucoma, it does not cover routine eye care services or regular eye exams, which are the core of what is typically needed.

Medicare Part A (inpatient services) covers vision care only when it is considered a medical problem. In this case, Medicare may cover a range of services and treatments related to chronic eye conditions such as:

• Surgical procedures to repair eye functions related to cataracts.
• Eyeglasses required after cataract surgery.
• Eye exams to diagnose serious eye conditions (in this case, Medicare covers the exams even if the results are not a serious vision problem).

Medicare Part B (outpatient services) covers only limited vision care, such as yearly glaucoma tests for high-risk individuals. It also covers cataract surgery—including the removal of the lens and use of implants—and vision correction (e.g., prescription glasses) required after cataract surgery.In this case, you’ll also be required to pay the 20% coinsurance of the amount approved by Medicare. Importantly, Medicare Part B does not otherwise cover vision exams or eyeglasses or contact lenses. 

Indeed, Original Medicare only covers routine eye care in certain circumstances such as:

• Annual eye exams if you have diabetes
• If you are high-risk for glaucoma (diabetes, family history of glaucoma, African American over 50, Hispanic over 65)

Does Medicare Advantage Cover Vision Services? 

All Medicare Advantage (Part C) plans will cover the Medicare-defined benefits described above. In addition, many Medicare Advantage plans offer extra vision benefits compared to original Medicare, which can be quite robust, depending on the plan options available to you. These can include annual routine eye exams, eyeglasses frame allowances, eyeglass lenses, and contact lenses, among others.

Medicare Part D (prescription drug plan) provides prescription drug coverage that may include specific drugs related to eye care, such as eye drops.