Does Medicare cover routine eye care?


In most cases, Medicare will not pay for routine eye care. However, a more specific answer to your question depends on what type of Medicare coverage you have and what type of eye care you need. Remember, there are two different coverage options for people with Medicare. People with Medicare can either get their Medicare benefits through Original Medicare, the traditional Medicare program administered directly through the federal government, or through a Medicare Advantage plan, also known as a Medicare private health plan.

 

If you have Original Medicare, Medicare will generally not pay for routine eye care. However, Medicare can make an exception and pay for routine eye care in the following situations:


If you have diabetes, Medicare helps to pay for an eye exam once every 12 months to check for eye disease due to diabetes.


If you are at high risk for glaucoma, Medicare helps to pay for an eye exam by a state-authorized eye doctor once every 12 months. You are considered to be at high risk for glaucoma if you have diabetes, have a family history of glaucoma, are an African American over age 50, or are a Hispanic American age 65 or older.


Medicare may also pay for eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Specifically, Medicare can cover cataract surgery, as well as eye exams to diagnose potential vision problems.

 

Keep in mind that Medicare generally does not cover eyeglasses or contact lenses, unless you have had cataract surgery. If you have Original Medicare, Medicare may cover one pair of eyeglasses or one set of contact lenses if you need them after cataract surgery.

 

If you get your Medicare benefits through a Medicare Advantage plan, your plan may offer more vision coverage than Original Medicare. Keep in mind, however, that most plans generally offer limited vision coverage. If you have a Medicare Advantage plan, contact your plan directly to learn more about your plan’s benefits, costs and rules.

 

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