Does Medicare Cover Eye Exams?

Routine eye exams vs. medically necessary eye care

Medicare draws a sharp line between a routine eye exam and a medically necessary one, and that line decides whether you pay everything or almost nothing.

A routine exam is the kind you get to update your glasses or contact lens prescription (an eye refraction). Original Medicare does not cover routine eye exams, so you pay 100% of the cost out of pocket.

A medically necessary exam is one done to diagnose or treat an eye disease or condition, such as diabetes-related eye damage, glaucoma, macular degeneration, or cataracts. These are covered under Medicare Part B, subject to the usual deductible and coinsurance.

• Routine exam for glasses or contacts: not covered, you pay all costs.
• Medically necessary exam for an eye disease: covered by Part B after the deductible, you pay 20%.

Diabetic eye exams and glaucoma screenings

If you have diabetes, Part B covers one diabetic retinopathy eye exam each year (once every 12 months), performed by an eye doctor who is legally allowed to do the test in your state. This is once a year, not more often, even if you have diabetes.

Part B also covers glaucoma screenings once every 12 months, but only for people considered at high risk for glaucoma.

For both the diabetic eye exam and the glaucoma screening, after you meet the Part B deductible you pay 20% of the Medicare-approved amount for the doctor's services.

• Diabetic retinopathy exam: covered once every 12 months if you have diabetes.
• Glaucoma screening: covered once every 12 months for high-risk people.
• High risk for glaucoma includes people who have diabetes, have a family history of glaucoma, are African American and age 50 or older, or are Hispanic and age 65 or older.
• Your cost for each: 20% of the Medicare-approved amount after the Part B deductible.

Macular degeneration and cataract surgery

Part B may cover diagnostic tests and treatment for age-related macular degeneration, including certain injectable drugs. After the Part B deductible, you generally pay 20% of the Medicare-approved amount for both the drug and the doctor's services.

Part B covers cataract surgery, including the implantation of a basic intraocular lens. You pay the Part B deductible plus 20% of the Medicare-approved amount. This is true whether the surgery uses traditional techniques or lasers, as long as it is medically necessary.

An exam to diagnose cataracts and determine whether you need surgery is a medically necessary exam, so it falls under Part B coverage rather than being treated as a non-covered routine exam.

Eyeglasses and contacts after cataract surgery

Medicare generally does not cover eyeglasses or contact lenses. There is one important exception.

After cataract surgery that implants an intraocular lens, Part B covers one pair of eyeglasses with standard frames, or one set of contact lenses. You get this benefit after each qualifying cataract surgery.

For these corrective lenses, after the Part B deductible you pay 20% of the Medicare-approved amount. Medicare only pays for standard frames, so if you choose upgraded frames you pay the extra cost yourself.

• Covered: one pair of glasses (standard frames) or one set of contacts per cataract surgery.
• Your cost: 20% of the Medicare-approved amount after the Part B deductible.
• Upgraded frames are an extra out-of-pocket cost.

What you pay in 2026

To receive any of the covered medical eye services, you must be enrolled in and paying for Part B. In 2026 the standard Part B monthly premium is $202.90.

Covered eye services use the standard Part B cost structure: you first meet the annual Part B deductible, then pay 20% coinsurance on the Medicare-approved amount. For 2026, the Part B deductible is $283 per year.

The one-time Welcome to Medicare preventive visit includes a simple vision test, but that basic check is not a substitute for a full eye exam.

• 2026 Part B standard premium: $202.90 per month.
• 2026 Part B annual deductible: $283.
• Coinsurance on covered eye services: 20% of the Medicare-approved amount after the deductible.

Medicare Advantage and routine vision

Many Medicare Advantage (Part C) plans offer extra vision benefits that Original Medicare does not, such as routine eye exams and an allowance toward eyeglasses or contact lenses.

These benefits are not standardized. The exam frequency, the dollar allowance for eyewear, the network of eye doctors, and your copays all vary by plan. Always confirm the details in the plan's Evidence of Coverage before you rely on a vision benefit.

Medicare Advantage plans must still cover everything Original Medicare covers, so the medically necessary eye care described above is included either way, though copays and networks differ from plan to plan.