Does Medicare pay for glasses?
Access to vision benefits varies based on the Medicare plan you have, and in some cases, eye exams and new glasses may not be covered at all.
So, if you have Medicare, before you schedule your next visit to the eye doctor, let’s review the routine vision benefits that are covered, and what you will have to pay out of pocket for an updated pair of glasses.
Does Medicare pay for glasses and eye exams?
Generally speaking, Medicare does not cover routine eye exams, eyeglasses or contact lenses. If you have an Original Medicare plan (Medicare Parts A and/or B), you will be required to pay 100% out of pocket for these vision costs.
However, Part B may help to cover the cost of an exam and other vision costs if you have certain eye health conditions. But you still need to do your homework before scheduling any exams or procedures.
For instance, if you have had cataract surgery to implant an intraocular lens and you’re hoping Part B will help cover the cost of corrective lenses post surgery, keep the following in mind:
- Your supplier must be enrolled in Medicare.
- You must meet your Part B deductible.
- Medicare covers one pair of glasses OR one set of contact lenses per cataract surgery.
- Any added costs for upgraded frames would be paid for out of pocket.
- You will be required to pay 20% of the Medicare-approved amount for corrective lenses after each cataract surgery.
If you want more coverage, Medicare Advantage Plans (Part C) offer added benefits, including routine vision costs like exams and eyeglasses.
SEE RELATED: Does Medicare pay for cataract surgery?
What does Medicare cover for vision?
Original Medicare will not cover the cost of eyeglasses, contact lenses or routine vision exams.
Medicare Advantage Plans, on the other hand, are health plans run by private insurance companies and combine the benefits of Medicare’s Hospital and Medical Insurance (Parts A and B). Plus, they include additional benefits like Medicare Prescription Drug Coverage (Part D) as well as services like routine eye exams and costs like eyeglasses, often for an extra premium.
While Medicare Advantage Plans cost a little more than Original Medicare, they’re worth considering as enrollment may still be cheaper than paying out of pocket for vision care.
In addition to annual vision exams, these vision benefits may include:
- Preventive eye exams
- Eyeglasses (both frames and lenses)
- Contact lenses
Please note that specific benefits may vary depending on the plans available in your area. For help selecting an individual health plan that includes vision benefits, visit the official website for Medicare.
SEE ALSO: Does Medicare cover eye exams?
Does Walmart accept Medicare for glasses?
If you’re enrolled in Medicare and had cataract surgery in the last 12 months, Medicare will cover glasses purchased at Walmart.
However, if you’re enrolled in Medicare or supplemental Medicare with your provider, you may want to call ahead to ensure your provider is in-network and will accept your insurance.
Why? Some independent optometrists lease their office space from Walmart, so the accepted forms of insurance often depend on the individual doctor and location.
Does Medicare pay for eyeglasses for diabetics?
Whether you have diabetes or you’re at risk, Medicare may help with the costs of certain tests, drugs, supplies and services.
Medicare also will pay for annual glaucoma screenings for high-risk individuals, including those with diabetes, a family history of glaucoma and African Americans who are age 50 or older. These screenings consist of a comprehensive eye exam, along with dilation and intraocular pressure (IOP) measurement.
Unfortunately, Medicare Part B won’t cover the cost of eyeglasses for diabetics unless they’ve had a vitrectomy or cataract surgery. Post-procedure, Medicare Part B will cover the cost of one pair of glasses or contact lenses from a Medicare-enrolled subscriber.
Does Medicare cover specialized eye treatments?
Medicare’s eye health coverage varies based on whether or not you have certain conditions. For example, Medicare Part B covers eye exams for diabetic retinopathy once a year if you have diabetes.
If you’re at high risk for glaucoma, Medicare Part B will cover tests every 12 months. Certain diagnostic tests and treatment for age-related macular degeneration (AMD) also are covered.
With Original Medicare, Part B deductibles will still apply and you will pay 20% of the Medicare-approved amount for these services. In a hospital outpatient setting, you would pay a copay.
LOOKING FOR AN EYE DOCTOR WHO ACCEPTS MEDICARE? Book an appointment with a local eye doctor near you.
