Can I Use Medicare for Eye Care Services?

Even if you don’t wear glasses, it’s good to know how Medicare can apply to certain eye care services. The American Academy of Ophthalmology recommends annual eye exams for older adults, especially since vision changes can be an early warning sign for high blood pressure, diabetes, and serious eye diseases that can lead to permanent vision loss.

Original Medicare has specific criteria regarding eye care, and here is what you need to know. Part A and Part B do not cover annual eye exams or prescription eyewear. This means if you have Part A and Part B, you generally pay 100 percent of the costs associated with annual eye exams, refractions, glasses, and contact lenses.

However, Medicare may pay for annual office visits if you have diabetes, cataracts, age-related macular degeneration or you are at risk for glaucoma. In this situation, the patient pays 20%of the professional fees after the Part B deductible is met. After the yearly deductible is met, Medicare will typically pay 80% of the professional services. However, refractions, glasses, and contact lenses are not covered.

How Does the Medicare Deductible Work?

Your deductible is the amount of money you have to pay for your healthcare and prescriptions before Medicare, other insurance, or your prescription drug plan starts paying for your healthcare expenses. This deductible will reset each year, and the dollar amount may be subject to change. Every year you’re an enrollee in Part B, you have to pay a certain amount out of pocket before Medicare will provide you with benefits for additional costs. Almost any item or service that Part B covers will count toward your deductible. For example, say you fall and break your arm. You go to the emergency room to get treatment. Part A and Part B have their deductibles that reset each year, and these are standard costs for each beneficiary that has Medicare.

What happens when you reach your Part A or Part B deductible? Typically, you’ll pay a 20% coinsurance once you reach your Part B deductible. This coinsurance gets attached to every item or service Part B covers for the rest of the calendar year. In this instance, you’d be responsible for 20% of the bill under Part B. Medicare would then pay for the other 80%.

Does Medicare Pay for Glasses or Contact Lenses?

Medicare generally does not cover any costs associated with prescription eyewear or contact lenses. We recommend keeping an eye on promotions throughout the year by signing up for our e-mail list at the bottom of this website. If you have a health savings account (HSA), you can take qualified withdrawals to pay for eye exams and glasses.

If you have any questions about how Medicare works, contact a Medicare representative at: www.medicare.gov/talk-to-someone. For questions about your claims or other personal Medicare information, login into your Medicare account online or call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

If you would like to inquire about scheduling an appointment with our team and discuss how Medicare may or may not apply to eye care services, click the link below.