Original Medicare, which includes parts A and B, does not cover routine eye exams for most people. However, it covers eye exams for people in certain groups. Medicare Advantage plans often covers eye exams, glasses, and contact lenses.
The American Academy for Ophthalmology (AAO) recommends that people aged 65 years and over have an eye exam every year or two. An ophthalmologist can recommend exactly how often a person should have an eye exam.
Medicare Advantage plans often cover routine eye exams. Medicare part B covers eye exams for people at high risk of certain eye conditions.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B covers eye exams for people in certain groups. Most Advantage plans (Part C) cover vision care, including eye exams.
Part B and eye exams
Original Medicare, which is made up of parts A and B, does not usually cover routine vision care, including eye exams. If a person has Original Medicare, they will be entirely responsible for any costs related to eye exams, eyeglasses, and contact lenses.
However, Part B may cover eye exams for people at high risk of certain conditions. These include:
- glaucoma screening for people with a high risk
- diabetic retinopathy eye exams
- AMD diagnostic tests and treatment
The monthly premium for Part B in 2024 is $174.70.
A person also must pay 20% of the Medicare-approved amount for any eye care that Part B does cover. The deductible of $240 also applies, so if a person has not yet met their deductible, they may need to pay more.
Learn more about what part B covers.
Advantage plans and eye exams
Over 99% of Medicare Advantage plans offered by private insurance companies provide vision care benefits, such as:
- routine eye exams
- eyeglasses
- contact lenses
Premiums, costs, and covered services vary by plan, so it is important to research Advantage plans to find the best coverage combination.
Learn more about what Medicare Advantage covers.
Medicare Part B covers eye exams for people at risk of developing the eye conditions glaucoma, diabetic retinopathy, and age-related macular degeneration (AMD).
Medicare Part B covers one glaucoma test every 12 months for people with a high risk of developing the condition. This includes:
- African American people who are at least 50 years old
- Hispanic people who are at least 65 years old
- anyone with a family history of glaucoma
- anyone with diabetes
Glaucoma usually does not cause symptoms until its later stages, but without treatment, it can lead to blindness. Therefore, it is essential for everyone to have regular eye exams, especially people with a high risk of glaucoma.
Learn more about Medicare and glaucoma care.
Medicare Part B covers yearly diabetic retinopathy eye exams. A person needs to see a doctor authorized by the state to conduct these exams. The doctor needs to have a contract with Medicare.
People with diabetes have an increased risk of diabetic retinopathy, which affects the vessels that supply blood to the retinas. The
Learn more about diabetic eye screening.
Medicare Part B covers certain tests and treatments related to AMD, an eye condition that can cause significant vision loss.
Part B may cover the costs of tests to diagnose AMD and monitor its progress, as well as some drugs that a doctor injects into the eye to help treat the condition.
Eye health resources
Visit our dedicated hub for more research-backed information and in-depth resources on eye health.
Worldmetrics.org provides the following information about the cost of eye exams:
- People without insurance may pay up to $200 for a comprehensive eye exam.
- On average, an eye exam for seniors costs around $125.
- People with vision insurance pay around $40 for an eye exam, on average.
- Retail chains, such as Walmart or Costco, may offer more affordable eye exams, starting at $50.
- Some community health clinics and government programs for people on low incomes may offer more affordable eye exams.
- Eye exams may be more expensive in urban areas than rural areas.
Depending on income and resources, a person may qualify for Medicaid. Medicaid covers medically necessary eye care, including treatment for eye injuries and conditions. Medicaid does not typically include routine eye exams, but it does cover eye exams that a doctor deems medically necessary.
A person can contact their state Medicaid department to ask about assistance with vision care.
Even if a person does not qualify for Medicaid and has no coverage through Medicare, other resources can help with paying for vision care.
Some examples include:
- EyeCare America: This organization is part of the AAO Foundation and provides eye exams for people with lower incomes.
- SightFirst: This program, operated by Lions Club International, helps people receive vision support, including eyeglasses.
- Mission Cataract USA: This program provides cataract surgery for people who may not otherwise be able to afford it.
- New Eyes for the Needy: This program helps people obtain single or lined bifocal lenses. A person needs to have an eye exam and receive a prescription before applying for the glasses.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Original Medicare covers some aspects of vision care but typically only for people with a higher risk of certain eye conditions.
A person may receive expanded coverage by purchasing a Medicare Advantage plan.
Other programs, including Medicaid and some privately run organizations, can also help cover the costs of vision care.