Does Medicare Cover Eye Exams?

Original Medicare does not pay for the eye exam for new glasses, or for the glasses. It does pay for eye care tied to a health problem, like diabetes, glaucoma or macular degeneration. If small print is getting harder to read, it helps to know who pays before you book. Glasses are covered only after cataract surgery. Medicare Advantage and Medicaid often pay for routine exams and glasses.

When Medicare pays for eye care

• If you have diabetes, Part B pays for a diabetic eye exam once a year.
• If you're at high risk for glaucoma, Part B pays for a test once every 12 months.
• If you have age-related macular degeneration, Part B may pay for tests and treatment, like some eye shots.
• After cataract surgery with a lens implant, Part B helps pay for one pair of glasses or one set of contacts.

Not sure Medicare will pay? Ask anyway, because the eye doctor's office can tell you what parts of a visit it covers. If you want a hand, a Pair Team advocate can help you sort it out.

What Medicare pays for

At a hospital clinic, you also pay the hospital a copay.

Who is at high risk for glaucoma?

Four groups are at high risk for glaucoma, Medicare.gov says. You can get the yearly test if one fits you:

• You have diabetes.
• Someone in your family has had glaucoma.
• You're African American and 50 or older.
• You're Hispanic and 65 or older.

An eye doctor who is allowed to do the test in your state must do it or oversee it.

Does Medicare pay for glasses?

Medicare pays for glasses only after cataract surgery. Part B helps pay for one pair of glasses with standard frames after each surgery with a lens implant. You can get one set of contacts instead. You pay 20% after the deductible, plus the extra cost of nicer frames. Get them from a supplier that participates in Medicare, or it won't pay. See what Medicare pays for cataract surgery.

What if I have an eye problem?

If you have an eye problem, like an infection, Medicare usually covers an eye doctor visit to check or treat it. You pay 20% after the deductible. Medicare skips the test that sets your glasses prescription, called a refraction. Federal rules leave it out even at a covered visit, so ask what it costs.

Does Medicare Advantage cover eye exams and glasses?

Medicare Advantage, a private plan that replaces Original Medicare, usually covers eye exams and glasses. Nearly everyone in a plan open to everyone is offered some vision care, KFF found.

The help is often small. In 2021, KFF found that almost everyone with vision coverage in a plan had a yearly dollar cap, $160 on average. Call your plan to ask what it pays for an exam and frames.

To compare plans, use Medicare's Plan Finder at Medicare.gov/plan-compare, or call 1-800-MEDICARE (1-800-633-4227). You can also get free help from your State Health Insurance Assistance Program (SHIP) at 1-877-839-2675. Medicare Open Enrollment runs each fall, October 15 to December 7.

If you also have Medicaid

Full Medicaid can pay for the routine eye care Medicare does not.

• In California, Medicaid covers a routine eye exam once every 24 months, plus glasses, says California's Department of Health Care Services (DHCS). Ask your Medicaid plan how often it pays for new glasses. See Medicare and Medicaid in California.
• In New York, Medicaid pays for an eye exam once every two years, by state rule. It pays for new glasses about every two years, or sooner if a doctor shows a health need. Contacts are only for eye disease, with approval first. See Medicare and Medicaid in New York.

What to do

1. Find an eye doctor who takes Medicare. See how to find a doctor who takes Medicare. Ask if they accept assignment, which means they take Medicare's price as full payment.
2. Say why you're coming when you book. For example, say "I need my yearly diabetic eye exam."
3. Ask what you'll pay for each part of the visit, like the refraction.
4. Before you buy glasses, call your Medicare Advantage or Medicaid plan. Ask what it pays and where you must buy.

What a Pair Team advocate does

When people ask us about eye care, there's often more going on, like diabetes or no ride. This is what we do:

• Find an eye doctor near you who takes Medicare, and book your yearly diabetic eye exam.
• Check what your Medicare Advantage or Medicaid plan pays for exams and glasses.
• Set up rides to and from eye visits and surgery.
• Help with what usually comes with it: diabetes supplies, food, utilities and housing.

An advocate is covered by Medicare if you qualify. It takes two minutes to find out.

Check if you qualify for a Pair Team advocate

Frequently asked questions

Does the "Welcome to Medicare" visit include an eye test?

Yes, the "Welcome to Medicare" visit includes a simple vision test, but not a full eye exam. It's a one-time visit in your first 12 months with Part B. You pay nothing if your provider accepts assignment.

Does Medigap pay for eye exams or glasses?

No, Medigap plans generally don't cover vision care, Medicare.gov says. Most do pay your 20% for covered eye care, like the diabetic eye exam.

Can an optometrist do my diabetic eye exam?

Whether an optometrist can do your diabetic eye exam depends on your state. The eye doctor must be legally allowed to do the test where you live, Medicare.gov says. Ask the office when you book.

What if I'm a Qualified Medicare Beneficiary (QMB)?

If you have QMB, eye doctors can't bill you for the 20% on care Medicare covers. QMB is one of the Medicare Savings Programs. It doesn't pay for routine exams or glasses, but full Medicaid can.

What does the diabetic eye exam check for?

The diabetic eye exam looks for diabetic retinopathy, eye damage that diabetes can cause. For the rest of your diabetes care, see what Medicare pays for diabetes supplies.

Sources

• Eye exams (routine), Medicare.gov
• Eye exams (for diabetes), Medicare.gov
• Glaucoma screenings, Medicare.gov
• Macular degeneration tests and treatment, Medicare.gov
• Eyeglasses and contact lenses, Medicare.gov
• Doctor and other health care provider services, Medicare.gov
• Particular services excluded from coverage (42 CFR 411.15), Legal Information Institute
• "Welcome to Medicare" preventive visit, Medicare.gov
• Learn what Medigap covers, Medicare.gov
• Joining a plan, Medicare.gov
• 2026 Medicare Parts A and B Premiums and Deductibles, CMS
• Essential Health Benefits, DHCS
• 18 NYCRR 505.6, Ophthalmic services, New York State Department of Health
• Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization, KFF
• Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries, KFF
• State Health Insurance Assistance Programs