Does Medicare Cover Eye Exams?

🔑 10 Key Takeaways

1. Medicare does not cover routine eye exams. Original Medicare doesn’t include coverage for routine vision services, including eye exams for contacts or glasses.

2. Medicare does cover “medically necessary” eye exams. If you have diabetes, glaucoma risk factors, or macular degeneration, Part B covers annual diagnostic eye exams at 80% after your deductible.

3. Cataract surgery is fully covered under Part B. Medicare Part B covers cataract surgery that implants conventional intraocular lenses, plus one pair of glasses or contacts afterward.

4. Glaucoma screenings are covered annually — but only for high-risk groups. Part B covers annual glaucoma exams if you have diabetes, family history of glaucoma, are African American and age 50+, or Hispanic and 65+.

5. A routine eye exam costs $75–$250 without insurance. VSP reports the average eye examination without vision coverage is $194. Retail chains can drop that to $50–$90.

6. The 2026 Part B deductible is $283. After meeting this deductible, Medicare pays 80% of covered eye services, and you pay 20% coinsurance.

7. Over 98% of Medicare Advantage plans offer vision benefits. Over 98% of Medicare Advantage plans are expected to offer vision benefits in 2026, including routine eye exams and eyewear allowances.

8. Medigap does not add vision coverage. Medicare Supplement plans only help pay for services already covered by Original Medicare — not routine vision care.

9. Medicare covers one pair of glasses after each cataract surgery. Medicare Part B will cover one pair of eyeglasses with standard frames or a single set of contact lenses after cataract surgery.

10. The “Welcome to Medicare” visit includes a basic vision screening. A simple vision test is included in your “Welcome to Medicare” preventive visit — but this is a one-time screening, not a comprehensive eye exam.

👁️ Medicare Covers Your Eyes — But Only When Something Is Already Wrong

The core frustration with Medicare’s vision policy boils down to one word: “routine.” Medicare draws an absolute line between checking your vision for a new glasses prescription (not covered) and diagnosing or treating a specific eye disease (covered). For the estimated 93 million American adults at high risk for serious vision loss, this distinction can mean the difference between catching a blinding condition early or discovering it too late.

When Medicare uses the word “routine,” it specifically refers to services aimed at correcting your vision rather than treating an eye disease.

👁️ Eye Service	❌ Routine (Not Covered)	✅ Medically Necessary (Covered)
Eye refraction (“which is better, 1 or 2?”)	❌ Never covered under Original Medicare	N/A
Comprehensive eye exam	❌ Not covered if just checking prescription	✅ Covered if diagnosing glaucoma, cataracts, AMD, diabetic retinopathy
Glasses/frames	❌ Not covered for regular prescriptions	✅ One pair with standard frames after cataract surgery
Contact lenses	❌ Not covered	✅ One set after cataract surgery
Glaucoma screening	N/A	✅ Once every 12 months for high-risk individuals
Diabetic retinopathy exam	N/A	✅ Once per year for all diabetics
Macular degeneration testing/treatment	N/A	✅ Diagnostic tests and certain injectable drugs covered
Cataract surgery	N/A	✅ Traditional and laser surgery covered under Part B
Retinal detachment repair	N/A	✅ Emergency and elective surgery covered
Eye prosthesis	N/A	✅ Covered for missing/shrunken eye

💡 The billing code trick your eye doctor knows: When you visit an ophthalmologist, the same comprehensive exam can be billed as either a “routine refraction” (not covered) or a “medical eye exam” (covered) depending on what the doctor finds and documents. If your doctor discovers a medical condition during what started as a routine visit — say, early signs of glaucoma or diabetic changes — the exam can often be rebilled under your medical insurance through Part B. Always ask your provider whether any findings during your exam qualify for medical billing.

Discover 12 Best Cell Phone Plans for Seniors

🔬 How Often Medicare Pays for Eye Exams: The Annual Screening Schedule Nobody Explains Clearly

Medicare doesn’t offer a universal annual eye exam benefit. Instead, it provides condition-specific screening frequencies that vary depending on your diagnosis and risk profile.

🩺 Condition	📅 How Often Medicare Pays	👤 Who Qualifies	💲 Your Cost (After $283 Deductible)
🟢 Diabetic retinopathy	Once every 12 months	Anyone diagnosed with diabetes	20% coinsurance
🔵 Glaucoma screening	Once every 12 months	High-risk: diabetes, family history, African American 50+, Hispanic 65+	20% coinsurance
🟡 Macular degeneration (AMD)	As medically necessary	Diagnosed AMD patients	20% coinsurance
🟠 Cataract monitoring	As medically necessary	Diagnosed cataract patients	20% coinsurance
🔴 Routine vision exam for glasses	Never	Nobody under Original Medicare	100% out of pocket
⚪ “Welcome to Medicare” vision test	Once (lifetime)	New Medicare enrollees within first 12 months	$0 (covered as preventive)

💡 The diabetes loophole that saves hundreds: If you have Type 1 or Type 2 diabetes — even well-controlled diabetes — you qualify for an annual dilated eye exam fully covered by Part B (after deductible and 20% coinsurance). Part B covers 80 percent of the cost of eye exams for diabetic retinopathy once every year if you are diagnosed with diabetes. During this medically necessary exam, your ophthalmologist will also check your overall visual acuity, effectively giving you a “routine” exam disguised as a medical one. Nearly 1 in 3 Medicare beneficiaries has diabetes — meaning a third of all seniors already qualify for annual covered eye exams and may not realize it.

🏥 Medicare Covers Cataract Surgery at 80% — and the One Pair of Glasses Most Seniors Don’t Know About

Cataract surgery is one of the most commonly performed procedures in the United States, and Medicare’s coverage is genuinely comprehensive here. More than 50% of Americans aged 80 or older have cataracts or have had cataract surgery.

Medicare Part B covers cataract surgery that removes a cloudy natural lens and, in most cases, replaces it with a clear artificial intraocular lens. This includes both traditional phacoemulsification and laser-assisted procedures.

🏥 Cataract Surgery Component	✅ Medicare Covers?	💲 Your Estimated Cost
Pre-surgery diagnostic exam	✅ Yes (Part B)	20% coinsurance after $283 deductible
Surgeon’s fee	✅ Yes (Part B)	20% coinsurance
Facility fee (ASC or hospital outpatient)	✅ Yes (Part B)	20% coinsurance
Anesthesia	✅ Yes (Part B)	20% coinsurance
Standard intraocular lens (IOL)	✅ Yes (Part B)	Included in surgery cost
Premium/multifocal IOL upgrade	❌ No — extra cost	$1,000–$4,000+ per eye out of pocket
One pair of glasses (standard frames) after surgery	✅ Yes (Part B)	20% coinsurance
One set of contact lenses after surgery	✅ Yes (Part B, alternative to glasses)	20% coinsurance
Post-operative follow-up visits	✅ Yes (Part B)	20% coinsurance
Prescription eye drops (post-surgery)	✅ Yes (Part D)	Varies by formulary
Designer/upgraded frames	❌ No	You pay the difference

For 2026, the national ambulatory surgery center payment rate for routine cataract surgery is approximately $1,255. The average total cost of cataract surgery ranges from $1,214 to $2,280 depending on the facility, with Medicare beneficiaries responsible for between $242 and $456 on average.

💡 The premium lens trap: Medicare covers one standard monofocal IOL per eye — the lens that corrects distance vision but still requires reading glasses. If your surgeon recommends a toric lens (for astigmatism) or a multifocal lens (for both distance and near vision), you pay the entire upgrade cost out of pocket. These premium lenses can add $1,000–$4,000 per eye. Ask your surgeon for a written estimate that clearly separates covered from non-covered charges before scheduling.

Discover Medicare Advantage vs. Medicare Supplement

🔍 Yes, Medicare Covers Glaucoma Surgery — and More Than Most Beneficiaries Realize

Glaucoma is the second leading cause of irreversible blindness worldwide, and Medicare provides surprisingly robust coverage for its diagnosis and treatment — once you’re classified as high-risk or diagnosed.

Glaucoma treatment is generally covered under Medicare. Outpatient laser surgery falls under Part B, and eye drops to address the condition fall under Medicare Part D.

🔬 Glaucoma Service	✅ Covered?	📋 Details
Annual glaucoma screening	✅ Part B	Must be high-risk; performed by state-certified eye doctor
Diagnostic testing (visual field, OCT, pachymetry)	✅ Part B	When ordered to diagnose or monitor glaucoma
Selective Laser Trabeculoplasty (SLT)	✅ Part B	Outpatient laser procedure; 20% coinsurance
Trabeculectomy (surgical)	✅ Part B	Covered when medically necessary
Minimally Invasive Glaucoma Surgery (MIGS)	✅ Part B	Increasingly common; often combined with cataract surgery
Prescription eye drops (timolol, latanoprost, etc.)	✅ Part D	Copay varies by formulary tier
Premium glaucoma drops (brand-name)	✅ Part D	May require prior authorization; higher tier copay

💡 Who counts as “high-risk” for glaucoma under Medicare: The qualifying criteria are broader than most people think. You’re eligible for annual Medicare-covered glaucoma screenings if you meet any one of these criteria: you have diabetes (any type), you have a family history of glaucoma in a first-degree relative, you are African American and 50 years or older, or you are Hispanic and 65 years or older. Given that approximately 38 million Americans have diabetes and millions more have family histories of glaucoma, a vast number of Medicare beneficiaries qualify for these screenings without knowing it.

💰 How Much a Routine Eye Exam Actually Costs (Since Medicare Won’t Pay)

For the millions of Medicare beneficiaries who don’t qualify for medically necessary eye exams, the full cost of routine vision care falls entirely on them. Here’s what to expect paying out of pocket in 2026.

🏪 Provider Type	💲 Average Cost Without Insurance	📌 Notes
💚 Retail chains (Walmart, Costco, Sam’s Club)	$50–$90	Cheapest option; Sam’s Club often ~$45–$50
🟢 Optical chains (America’s Best, LensCrafters)	$50–$100	America’s Best: ~$50 or free with 2-pair purchase
🟡 Independent optometrist	$100–$200	Higher for first visit; ~$150 for returning patients
🟠 Ophthalmologist	$150–$300	Most expensive; often includes more advanced testing
🔴 Add-on: contact lens fitting	+$100–$250	Billed separately from comprehensive exam
🔴 Add-on: retinal imaging	+$35–$50	Optional but recommended; not always included
🔴 Add-on: pupil dilation	+$20–$50	May be included or extra depending on provider

The national average cost of an annual routine eye exam for patients without a vision insurance plan is $136 but can range from $105 to $257.

💡 The hidden cost of skipping routine exams: According to the American Academy of Ophthalmology, eye exams can detect over 20 systemic health conditions — including diabetes, hypertension, autoimmune diseases, and even certain cancers — before symptoms appear elsewhere in the body. Skipping a $136 eye exam to save money may mean missing early signs of conditions that cost tens of thousands to treat once advanced. For seniors on tight budgets, community health centers, Lions Club chapters, and EyeCare America (a public service program from the AAO) offer free or significantly reduced eye exams.

Discover How I Found Senior Apartments Under $500 a Month

📋 Medicare Advantage: Where 98% of Plans Cover What Original Medicare Won’t

If Original Medicare’s vision gaps feel unacceptable, Medicare Advantage (Part C) is where the overwhelming majority of beneficiaries find relief. These privately administered plans must cover everything Original Medicare covers — plus most add substantial vision benefits.

Over 98% of Medicare Advantage plans are expected to offer vision benefits in 2026, maintaining a trend similar to that of 2025.

👓 Typical Medicare Advantage Vision Benefits	📊 How Common	💲 Typical Cost to You
Annual routine eye exam	Very common (~98% of plans)	$0–$40 copay
Eyewear allowance (glasses or contacts)	Very common	$100–$400/year allowance
Prescription lens coverage	Common	Included in eyewear allowance
Frames coverage	Common	Standard frames covered; upgrades extra
Contact lens fitting	Some plans	Copay may apply
Diabetic eye exam	Required (same as Original Medicare)	$0–$20 copay
Glaucoma screening	Required (same as Original Medicare)	$0–$20 copay
Cataract surgery	Required (same as Original Medicare)	Plan-specific copay; may be lower than Original Medicare coinsurance

💡 The trade-off nobody mentions: Medicare Advantage plans offer superior vision benefits but typically restrict you to a network of providers. If your preferred ophthalmologist or optometrist is out-of-network, you may face significantly higher costs or no coverage at all. Before enrolling, verify that your eye care providers participate in the plan’s network — especially if you’re mid-treatment for a chronic condition like glaucoma or macular degeneration.

🗺️ State-by-State: How Your Location Affects Medicare Vision Coverage

While Medicare itself is a federal program with uniform rules, the practical reality of eye care coverage varies significantly depending on where you live. This is because Medicare Advantage plan availability, Medicaid supplemental vision benefits, and state-funded vision programs all differ by state.

States with Medicaid vision benefits for dual-eligible beneficiaries (Medicare + Medicaid):

Seniors who qualify for both Medicare and Medicaid (“dual eligibles”) often receive vision benefits that fill Medicare’s gaps. Medicaid vision coverage varies dramatically by state.

🗺️ State Coverage Category	📍 Examples	👓 What Medicaid Typically Covers
🟢 Comprehensive vision benefits	New York, Massachusetts, California, Minnesota, Connecticut	Annual exams, glasses, contact lenses, lens replacements
🟡 Limited vision benefits	Texas, Florida, Georgia, Ohio, Pennsylvania	One exam every 1–2 years; basic frames; limited lens options
🟠 Emergency/medical only	Alabama, Arizona (limited), Wyoming	Only medically necessary services; no routine coverage
🔵 Recently expanded	Colorado, Oregon, Washington, Virginia	Broader exam and eyewear coverage added in recent years

State-specific programs and resources for Medicare beneficiaries:

🏛️ Program	📍 Availability	👤 Who Qualifies	💡 What It Offers
EyeCare America (AAO)	All 50 states	Seniors 65+; no eye exam in 3+ years	Free comprehensive eye exam and up to one year of care
Lions Club Vision Programs	All 50 states	Low-income individuals	Free or reduced-cost exams and glasses
State pharmaceutical/vision assistance programs	Varies	Low-income Medicare beneficiaries	Exam subsidies and eyewear vouchers
Federally Qualified Health Centers	All 50 states	Income-based sliding scale	Eye exams at reduced rates; some sites have optometrists
Veterans Affairs eye care	All 50 states	Enrolled veterans	Comprehensive vision care including exams and glasses

💡 The dual-eligible advantage most people miss: If you qualify for both Medicare and Medicaid (dual eligibility), your state’s Medicaid program almost certainly covers routine eye exams and basic eyewear — services that Medicare alone refuses to pay for. Approximately 12 million Americans are dual-eligible, and many don’t realize their Medicaid benefits include vision care that supplements their Medicare coverage. Contact your state Medicaid office to learn exactly what vision services are included.

🧪 Macular Degeneration: The Expensive Condition Medicare Quietly Covers Well

Age-related macular degeneration (AMD) affects roughly 20 million Americans and is the leading cause of severe vision loss in people over 50. Medicare’s coverage for AMD is actually more comprehensive than most beneficiaries expect.

🔬 AMD Service	✅ Medicare Covers?	💲 Typical Cost to You
Diagnostic eye exam	✅ Part B	20% coinsurance after deductible
Optical Coherence Tomography (OCT)	✅ Part B	20% coinsurance
Fluorescein angiography	✅ Part B	20% coinsurance
Anti-VEGF injections (Lucentis, Eylea, Avastin)	✅ Part B	20% coinsurance per injection
Photodynamic therapy	✅ Part B	20% coinsurance
Low-vision rehabilitation	✅ Part B (limited)	20% coinsurance
Magnifying glasses/low-vision aids	❌ Not covered	100% out of pocket

💡 The Avastin vs. Lucentis cost difference your doctor may not mention: Both drugs treat wet AMD effectively, but Lucentis costs approximately $1,800–$2,000 per injection while Avastin (used off-label) costs roughly $50–$70 per injection. Medicare covers both, but your 20% coinsurance on Lucentis means you pay $360–$400 per treatment versus $10–$14 for Avastin. With injections needed monthly or every few months, this adds up to thousands of dollars annually. Ask your ophthalmologist which drug they recommend and why — the clinical evidence shows nearly identical results for most patients.

❓ Frequently Asked Questions

Does Medicare cover anything for the eyes?

Yes, but only medically necessary services. Medicare Part B covers annual diabetic retinopathy exams, annual glaucoma screenings for high-risk individuals, macular degeneration diagnosis and treatment (including anti-VEGF injections), cataract surgery with a standard IOL, one pair of glasses or contacts after cataract surgery, and emergency eye injury treatment. What it does not cover is routine vision exams for prescription glasses or contacts, regular eyeglasses, contact lenses, or refractive eye surgeries.

How often does Medicare pay for eye exams?

It depends entirely on your condition. Diabetics receive one covered dilated eye exam per year. High-risk glaucoma patients receive one screening per year. AMD patients receive exams as medically necessary. For everyone else without a qualifying condition, Medicare pays for zero routine eye exams — ever.

Does Medicare cover eye exams for seniors who just need glasses?

No. This is the single most common misunderstanding about Medicare. Original Medicare (Parts A and B) does not cover routine eye exams, or the purchase of eyeglasses or contact lenses. If you need a prescription update for reading glasses or distance glasses, you pay 100% of the exam and eyewear cost. Medicare Advantage plans, standalone vision insurance, or state Medicaid programs (for dual-eligible beneficiaries) are the primary alternatives.

Does Medicare cover eye surgery for glaucoma?

Yes. Glaucoma treatment is generally covered under Medicare, including outpatient laser surgery under Part B and eye drops under Part D. This encompasses Selective Laser Trabeculoplasty, trabeculectomy, minimally invasive glaucoma surgery (MIGS), and implant procedures when deemed medically necessary. You pay 20% coinsurance after the Part B deductible.

Does Medicare cover cataract surgery?

Yes — this is one of Medicare’s most comprehensive coverage areas. Part B covers the surgical procedure (traditional or laser), the standard intraocular lens implant, pre-operative and post-operative care, facility and anesthesia fees, and one pair of corrective eyeglasses or contact lenses afterward. Without private insurance or Medicare, the out-of-pocket expense for cataract surgery can range from $3,000 to $6,000 per eye. With Medicare, your share drops to roughly $242–$456 on average.

How much does a routine eye exam cost for Medicare beneficiaries?

Since Original Medicare doesn’t cover routine exams, you pay the full retail price. Without vision insurance, the average cost of an eye exam is about $75–$250, with costs varying based on provider type. Budget retailers like Walmart ($75+), Sam’s Club ($45–$50), and America’s Best ($50 with eyewear purchase) offer the lowest-cost options. Independent ophthalmologists typically charge $150–$300 for a comprehensive first visit.

Should I switch from Original Medicare to Medicare Advantage just for vision coverage?

Not necessarily. Adding a standalone vision insurance plan (typically $10–$25/month) to Original Medicare gives you routine exam coverage and an eyewear allowance without sacrificing provider choice or the flexibility of traditional Medicare. Medicare Advantage offers more comprehensive vision benefits, but it limits you to a provider network and may affect coverage for other services. Weigh the total package — not just vision — before switching.

Are there any free eye care programs for seniors on Medicare?

Yes. EyeCare America (a program of the American Academy of Ophthalmology) provides free comprehensive eye exams and up to one year of follow-up care for qualifying seniors 65 and older who haven’t seen an ophthalmologist in three or more years. The Lions Club International also offers free exams and eyewear through local chapters. Many states run additional senior vision assistance programs — contact your State Health Insurance Assistance Program (SHIP) for referrals specific to your area.

The bottom line: Medicare’s vision coverage is a study in contradictions — it will pay thousands for cataract surgery but won’t cover a $136 eye exam to prescribe reading glasses. The key to navigating this system is understanding that the word “medically necessary” unlocks coverage that “routine” locks out. If you have diabetes, a family history of glaucoma, or any diagnosed eye condition, you likely qualify for more covered eye care than you realize. For everything else, Medicare Advantage plans, standalone vision insurance, and community programs fill the gaps that Original Medicare stubbornly refuses to close.

Blog