Medicare Eye Care Coverage: What Is and Is Not Covered

Vision problems are extremely common among Medicare beneficiaries -- yet Original Medicare covers very little routine eye care. Understanding exactly what is and is not covered helps you plan for eye care costs and avoid surprises.

Original Medicare (Parts A and B) does not cover:

• Routine eye exams for glasses or contact lens prescriptions
• Eyeglasses (frames and lenses)
• Contact lenses (except after cataract surgery with an IOL)
• Most refractive procedures (LASIK, PRK)

These are considered routine vision care -- not medically necessary services -- and are excluded from Original Medicare coverage.

Cataract surgery is one of the most common procedures performed on Medicare beneficiaries -- and it is covered under Part B.

What's covered:

• The surgical procedure (phacoemulsification)
• Standard intraocular lens (IOL) implant
• One pair of eyeglasses OR contact lenses after cataract surgery (the only time Medicare covers glasses)
• Pre- and post-operative care

What's not covered:

• Premium IOLs (multifocal, toric/astigmatism-correcting lenses) -- you pay the upgrade cost
• LASIK to reduce dependence on glasses after cataract surgery

Cost: 20% coinsurance after the Part B deductible. Medigap Plan G covers this 20%.

Medicare covers one glaucoma screening per year for high-risk individuals:

• People with diabetes
• People with a family history of glaucoma
• African Americans age 50 and older
• Hispanic Americans age 65 and older

Cost: 20% coinsurance after the Part B deductible.

Medicare covers one dilated eye exam per year for people with diabetes to screen for diabetic retinopathy -- a leading cause of blindness.

Cost: 20% coinsurance after the Part B deductible.

Age-related macular degeneration (AMD) is the leading cause of vision loss in Americans over 60. Medicare covers:

• Diagnostic testing (optical coherence tomography, fluorescein angiography)
• Intravitreal injections (anti-VEGF therapy: Avastin, Lucentis, Eylea) for wet AMD
• Photodynamic therapy for certain cases

Cost: 20% coinsurance after the Part B deductible. Anti-VEGF injections can cost $1,000-$2,000 per injection, making Medigap coverage extremely valuable for AMD patients.

Medicare covers treatment for eye infections, injuries, and other acute eye conditions under Part B.

Eye surgery requiring hospitalization is covered under Part A.

Since Original Medicare doesn't cover routine vision, you have several options:

Medicare Advantage: Most MA plans include a vision benefit -- typically one routine eye exam per year and an annual allowance ($100-$300) for glasses or contacts. This is one of the most popular MA extra benefits.

Standalone vision insurance: Available for purchase separately. Typically $15-$30/month and covers routine exams and glasses.

Discount vision programs: VSP, EyeMed, and similar programs offer discounted rates without traditional insurance.

Community health centers: Federally qualified health centers often provide vision services on a sliding-fee scale.

• Get a comprehensive dilated eye exam at least every 1-2 years
• If you have diabetes, get your annual diabetic eye exam -- diabetic retinopathy is preventable with early detection
• Report any sudden vision changes, floaters, flashes, or vision loss to your eye doctor immediately -- these can indicate retinal detachment or other emergencies

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.