Whether Medicare covers your eye exam depends on why you're getting it. Here's the difference that matters.
Which eye exams does Medicare cover?
Original Medicare does not cover routine eye exams to check your vision and prescribe glasses or contacts. However, it does cover medically necessary eye exams and tests when you have or are at risk for an eye disease. Part B covers yearly glaucoma screening for people at high risk, annual eye exams for diabetic retinopathy if you have diabetes, and tests and treatment for age-related macular degeneration. It also covers eye exams related to treating a medical eye condition or injury. The key distinction is medical versus routine. Call 1-800-MEDIGAP at 1-800-633-4427 to understand what your situation qualifies for.
How to get routine eye exam coverage
If you want coverage for routine eye exams, the main option is a Medicare Advantage (Part C) plan that includes a vision benefit, which often covers an annual routine exam plus an allowance for glasses or contacts, usually within a network. Standalone vision insurance plans are another option that work alongside Original Medicare or Medigap. Medigap plans do not add routine vision benefits, they pay Original Medicare's out-of-pocket costs. Choosing the right approach depends on your eye health and budget. To compare Medicare Advantage plans with vision benefits at no cost, call 1-800-MEDIGAP at 1-800-633-4427.