December 20th 2023
By Ari Parker
While Medicare does not cover eyeglasses and contact lenses for general vision correction, you can get coverage after cataract surgery. Learn more about what Medicare can cover for eye care in this post.
By Ari Parker
Eye and vision problems become more and more common as we grow older. While 92% of Medicare beneficiaries wear glasses to correct vision issues, Original Medicare does not cover the cost of glasses, contact lenses, or routine eye exams.
There’s only one situation where Medicare can cover eyeglasses—after cataract surgery. Keep reading to learn more about what Medicare does and doesn’t cover when it comes to vision services.
Medicare does not cover eyeglasses, contact lenses, or routine eye exams for general vision correction.
Medicare does cover glasses and contact lenses if you have cataract surgery.
Medicare Advantage enrollees may have coverage for eyeglasses, but plan details vary. Check your summary of benefits to see if your plan covers eyeglasses.
You can get Medicare coverage for other vision-related exams and treatment for conditions like diabetes, macular degeneration, and glaucoma.
If you’ve needed glasses before, you know that corrective lenses are vital to your wellbeing. Glasses and contact lenses help you see near and far by focusing light directly onto the retina. Without wearing glasses, your vision could become worse over time.
In general, Medicare does not cover eyeglasses and contact lenses if you need them for general vision correction. If you have cataract surgery, which involves implanting a lens that replaces your eye’s natural lens, Medicare will cover one pair of eyeglasses or one set of contact lenses following the procedure.
Medicare also covers a yearly eye exam for people with diabetic retinopathy. It also covers glaucoma screenings if you’re at high risk for developing the eye disease. You may receive coverage to treat other chronic eye conditions when medically necessary.
Medicare covers cataract surgery and any follow-up care, including eyeglasses if they’re needed after the procedure. The reason you might need glasses is because the intraocular lens that is implanted in your eye during cataract surgery usually focuses on things at a distance. These intraocular lenses are called monofocal lenses. With a monofocal lens, your vision for seeing things far away could improve, but in many cases you’ll still need reading glasses for seeing things up close.
Monofocal lenses are the most popular type of intraocular lens, but your doctor may recommend a multifocal lens, which allows you to see things up-close and far away. If you have a multifocal lens implanted during cataract surgery, you’re less likely to need glasses after your surgery.
Original Medicare pays for 80% of any covered service, including cataract surgery. After you meet your Part B deductible, you are responsible for covering 20% of the cost of one pair of eyeglasses with standard frames or one set of contact lenses. If you have a Medicare Supplement plan, your out-of-pocket costs will be reduced.
Two things to keep in mind:
You’ll have to pay for any additional frames.
Medicare will only pay for the glasses and contact lenses from places that are enrolled in Medicare. Rules around this are strict—you won’t get the eyewear reimbursed if they are not Medicare-approved (even if your supplier submits a claim).
Medicare Advantage plans are a bundled, private health insurance alternative to Original Medicare. Most Medicare Advantage plans cover extra benefits, like routine vision care.
Medicare Advantage vision coverage typically includes routine vision exams, eyeglasses, and contact lenses. There’s usually an annual limit to vision coverage and how many times you can get a new pair of glasses. Plans either cover one pair of prescription eyeglasses every year or one pair every other year. Coverage and out-of-pocket costs vary from plan to plan, so it’s important to understand what your plan covers and how much you’ll owe out of pocket before receiving services or purchasing eyeglasses.
With a Medicare Advantage insurance policy, you'll likely have to pay out of pocket for upgrades and accessories, like prescription sunglasses.
While Medicare doesn’t cover routine eye exams for eyeglasses and contact lenses, it does cover exams and treatment for other vision-related issues caused by conditions like diabetes, macular degeneration, glaucoma, and, as we’ve discussed in this post, cataracts.
There are a few different ways you can get discounted eyeglasses. Here are a few tips to save money:
Compare eyewear prices from different companies: Researching costs for eyeglasses and contact lenses from multiple providers, including online retailers, can help you find discounts and a price that works for you.
Ask a provider: Consult with your primary care physician or pharmacist about low-cost options for eyewear near you.
Medicare coverage for eyeglasses and contact lenses is limited, but if you have more questions about your plan and what it covers, speak to one of our licensed Advisors who are happy to help. Get the most out of Medicare, and get in touch with us by calling (855) 900-2427 or picking a time to chat.
