Does Medicare Cover Eye Exams?

Thanks to Medicare, you have coverage for all of the routine checkups you need. But what about your eyes?

If you are wondering if your medicare benefits cover visits to the eye doctor, read on.

Find yourself asking, “Does Medicare cover eye exams?” Here's everything you need to know.

Age-Related Eye Problems

As we age, people should be aware of certain eye conditions. Some age-related eye conditions include:

  • Presbyopia–the inability to read the fine print (or see small objects clearly)
  • Glaucoma–increased pressure inside the eye that can lead to blindness
  • Cataracts–Cloudy buildup in the front part of the eye that can lead to vision impairment
  • Retinal Disorders–problems with the retina that can interfere with the ability to transfer images
  • Eye Injuries

So what does Medicare have to do with all of this? If our eyes face inevitable problems with age, shouldn't all Medicare plans cover all routine eye exams?

When Does Medicare Cover Eye Exams?

The Original Medicare Plans (Part A and B) do not cover routine eye exams. For most regular eye health checkups, you will have to pay 100% out of pocket.

Thankfully, Medicare Part B covers exams for age-related eye problems. Glasses, while important, are not as urgent as a glaucoma exam, and Medicare accounts for these specific needs as we age.

Medicare covers eye exams and, in some cases, surgery for these conditions:

  • Diabetes – Advanced stages of diabetes can lead to retinal problems and eventually to blindness if left unchecked. If you have been diagnosed with diabetes, Medicare Part B will cover one exam annually to test for diabetic retinopathy.
  • Glaucoma – Medicare Part B also entitles you to an annual glaucoma exam if you have certain risk factors. For example, if you are over 50 and African American, over 65 and Hispanic, have diabetes or a family history of Glaucoma, you may qualify.
  • Macular Degeneration – Medicare also entitles you to exams and diagnostic tests–as well as medication, if necessary–for macular degeneration.
  • Eye Injuries and Diseases – Medicare will cover an injury to your eye just as it would an injury anywhere else. It also covers eye diseases and treatments such as Lucentis, Aflibercept, and ocular photodynamic therapy.

Medicare Advantage Plans

If you are fortunate enough to maintain healthy eyes, your doctor may not see a need to send you to an eye specialist. But if you still need the type of vision coverage that offers walk-in eye exams, look at the Medicare Advantage plans.

Medicare Advantage plans are plans offered by private, medicare-approved insurance companies. If you need insurance, you can compare Advantage plans here.

Know Your Options

Don't wait until your primary physician sees that you have eye problems. If you are wondering, “Does Medicare cover eye exams?” The answer is yes. 

Contact a licensed insurance agent to learn about your options.

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