Medicare is a national health insurance program, but Medicare plans can differ widely from state to state and plan to plan—especially where vision care is concerned. It’s important to understand what is and isn’t covered by Medicare when it comes to your eye health needs.*

Medicare and routine eye exams

Medicare generally does not cover routine eye exams for eyeglasses or contacts. It does, however, cover eye injuries. In such an instance, you would be responsible for your Part B deductible and 20% of Medicare’s payment to the provider. 

Medicare Part C, also known as a Medicare Advantage plan, may or may not offer vision coverage. Check with your insurance provider.

Medicare and cataract surgery 

A cataract is a cloudiness in the lens of the eye that blocks light from entering and sometimes causes blurred vision. 

Medicare Part B covers the following for cataract surgery:

• A conventional intraocular lens (IOL) implanted during the surgery
• Facility and physician services and supplies required to insert a conventional IOL during the surgery
• One pair of eyeglasses with standard frames or one set of contact lenses from a Medicare-enrolled supplier if you have an IOL implanted during surgery

For eyeglasses, you would pay 20% of the Medicare-approved amount, along with the Part B deductible, after each cataract surgery with IOL implantation. You would also be responsible for the difference in price for upgraded frames. 

If you choose presbyopia-correcting (P-C) or astigmatism-correcting (A-C) lens implantation instead of a conventional one, Medicare will not pay for physician and facility services regarding:

• insertion, 
• adjustment, and 
• follow-up treatments related to the P-C or A-C IOLs. 

Medicare and glaucoma

Glaucoma, if untreated, causes vision loss by damaging the optic nerve. 

High-risk factors for glaucoma include:

• Diabetes
• Family history of glaucoma
• African American ancestry and age 50 or older
• Hispanic ancestry and age 65 or older

If you meet the above criteria, Medicare Part B covers glaucoma tests once every 12 months. You would either pay 20% of the Medicare-approved amount or a copay and the deductible, depending on the treatment setting. 

Glaucoma screening tests include a:

• Dilated eye exam
• Intraocular pressure measurement
• Direct ophthalmoscopic or a slit-lamp biomicroscopic examination

If your doctor recommends more (or more frequent) services than are allowable under Medicare or services that are not covered under Medicare at all, you may be responsible for all costs. Speak with your provider about projected costs before receiving treatment.

Medicare and diabetes

In addition to causing cataracts and glaucoma, diabetes also increases your risk for developing certain eye diseases, such as retinopathy and macular edema. 

Diabetes-related retinopathy occurs when small blood vessels leak and bleed in the retina. This disease affects more than one in four (1 in 4) American adults living with diabetes. Diabetes-related macular edema can accompany retinopathy. This disease occurs when small blood vessels in the center of the retina leak, which causes your retina to swell and vision to blur.  

The annual glaucoma screening benefit includes a comprehensive eye exam. If you have Medicare and are living with diabetes, you are eligible for this benefit. Use it to get screened yearly for both glaucoma and diabetes-related retinopathy. 

Medicare and age-related macular degeneration

Age-related macular degeneration (AMD) is a progressive disease that causes central vision loss. Left untreated, it can lead to blindness.

If you have AMD, Medicare Part B may cover certain diagnostic tests and treatments for eye disease, including certain injected drugs. You would either pay 20% of the Medicare-approved amount or a copay and the deductible, depending on the treatment setting.  

If your doctor recommends tests or treatments that are not covered or that cost more than what is allowed, you may be responsible for all costs. Ask your provider about coverage before undergoing recommended tests or treatments. 

Medicare Part D and prescription drugs

Medicare Part D helps defray the costs of prescription drugs, including eye medications. Part D is available to all Medicare beneficiaries. You must specifically be enrolled in Part D to take advantage of this optional benefit. Those who miss enrollment deadlines are penalized. 

Medicare plans vary, so contact a Medicare specialist to learn more about plans in your state and sign up or change your plan. 

*Prevent Blindness. (n.d.) Medicare Benefits and Your Eyes. https://preventblindness.org/medicare-benefits-your-eyes/