Coverage by Plan Type
Covers medically necessary eye care only. Part B covers annual eye exams for diabetic retinopathy (for people with diabetes), glaucoma tests for high-risk individuals, and cataract surgery including one pair of corrective lenses after surgery. Routine eye exams and glasses are not covered.
Most Medicare Advantage plans include routine vision benefits as an extra benefit. Typically covers one routine eye exam per year and an allowance toward glasses or contact lenses, usually $100 to $300 per year. Some plans offer additional discounts through vision networks like EyeMed or VSP.
Medigap plans do not add routine vision coverage. They cover cost-sharing gaps in Original Medicare, so they would cover your 20% coinsurance for medically necessary eye procedures, but not routine exams or glasses.
Standalone vision insurance plans are available from private insurers, typically $10 to $25 per month. These cover routine exams and provide allowances for frames and lenses. Vision discount programs (not insurance) are also available for reduced rates at participating providers.
What Original Medicare Covers
Original Medicare Part B covers eye care in specific medical circumstances. Annual dilated eye exams for diabetic retinopathy are covered for people with diabetes. Glaucoma tests once every 12 months are covered for people at high risk, including those with diabetes, a family history of glaucoma, African Americans age 50 and older, or Hispanic Americans age 65 and older. Cataract surgery is covered, including one pair of eyeglasses or contact lenses after each cataract surgery. Macular degeneration treatment, including injections, is covered when medically necessary. All other routine eye care, including standard eye exams, glasses, and contacts, is not covered by Original Medicare.
What Medicare Advantage Covers
Most Medicare Advantage plans offer routine vision benefits beyond Original Medicare. A typical vision benefit includes one routine comprehensive eye exam per year and an annual allowance toward eyeglasses frames and lenses or contact lenses, usually $100 to $300. Many plans partner with vision networks such as EyeMed, VSP, or Davis Vision, giving you access to a wide network of optometrists and optical retailers. Coverage details vary significantly by plan. Always check the Evidence of Coverage document for your specific plan.
Low Vision Aids and Services
If you have significant vision impairment, Original Medicare Part B may cover low vision aids and services when prescribed by a doctor as medically necessary. This can include certain optical aids used to treat vision loss from conditions like macular degeneration. However, standard eyeglasses and contact lenses for refractive errors such as nearsightedness, farsightedness, and astigmatism are not covered.
Also Missing from Original Medicare: Dental Coverage
Like vision, routine dental care is excluded from Original Medicare. Medicare Advantage plans often bundle dental, vision, and hearing benefits together. If you are considering switching to Medicare Advantage for vision coverage, it is worth comparing dental benefits at the same time.
Does Medicare Cover Dental?Practical Tips
- If you have diabetes, make sure you are getting your annual diabetic retinopathy exam. It is covered by Part B.
- If you are at high risk for glaucoma, your annual glaucoma test is covered. Ask your doctor.
- Compare Medicare Advantage plans during Annual Enrollment to find one with strong vision benefits in your area.
- Retail chains like Costco, Walmart, and Sam's Club offer significantly lower prices on glasses even without vision insurance.
Frequently Asked Questions
Still Have Questions?
A licensed MIP agent can explain your coverage options and help you find a plan that includes vision benefits.
Call 813-699-5559