Do Medicare Advantage Plans Cover Vision Care?

Do Medicare Advantage Plans Cover Vision Care? Routine vision care is essential for overall good health, well-being, and your independence. An annual eye exam gives your ophthalmologist and physician the ability to detect vision problems like astigmatism, nearsightedness, farsightedness, and other diseases like macular degeneration. These exams can also detect high blood pressure, diabetes, and other issues that may affect your general health. 

Medicare Benefits Solutions

Sep 6, 2021

 4 minutes read

Maintaining good vision by getting glasses, or updating corrective lenses when there are changes in eyesight can help you avoid accidents around the house, keep you safe while driving, and allow you to enjoy life more because you can see your environment better. And routine eye exams can prevent dangerous complications from health conditions like diabetes.

Unfortunately, Original Medicare Part A and Part B do not cover routine eye exams (eye refractions) and eyeglasses and beneficiaries pay 100 percent of the cost.

If you are enrolled in Medicare now, or if you’ll be eligible for Medicare soon, you should have information about what type of Medicare plan you need for vision care coverage.

Do Medicare Advantage (Part C) plans cover vision care?

Medicare Advantage (MA) plans, also known as Medicare Part C, are Medicare plans sold by private insurance companies that are Medicare-affiliated. U.S. federal law requires all MA plans to provide, at least, the same benefits that you would get from Original Medicare Part A (inpatient hospital insurance) and Part B (outpatient medical insurance).

Do Medicare Advantage (Part C) plans cover vision care?

Medicare Advantage (MA) plans, also known as Medicare Part C, are Medicare plans sold by private insurance companies that are Medicare-affiliated. U.S. federal law requires all MA plans to provide, at least, the same benefits that you would get from Original Medicare Part A (inpatient hospital insurance) and Part B (outpatient medical insurance).

Medicare Advantage plans that add routine vision care services to the coverage, typically include the following services:

  • Routine eye exams 
  • Preventive eye exams
  • Eyeglasses and/or contact lenses pairs up to plan limits
  • Upgraded eyeglass frames


Your plan may restrict your eye exams to one time per year. Make sure you have the details before committing to a plan. Depending on your plan, you may also have an option for buying eyeglass frames from specific retailers like Warby Parker which are also available online.

How does Original Medicare cover vision care services?

If you currently have health care coverage with Medicare Part A and B, you have the following limited benefits for specific vision care services:

Eye exams for diabetics

If you are diabetic, Medicare Part B allows one eye exam per year for diabetic retinopathy. Your benefits cover 80 percent of the exam if the eye doctor is legally permitted to perform the exam in your service area. You are responsible for the remaining 20 percent of the Medicare-approved amount for the doctor’s visit. You are also responsible for your Part B deductible. 

Glaucoma examinations

Medicare Part B covers glaucoma examinations once a year if you are at high risk. Medicare considers the following people to be at high risk for glaucoma:

  • Diabetics
  • Those with a family history of glaucoma
  • African Americans over age 50
  • Hispanics over 65

Medicare Part B benefits cover 80 percent of the Medicare-approved cost for the exam. You are responsible for the remaining 20 percent as well as your Part B deductible. If the exam is done in a hospital outpatient setting, you are also responsible for a copayment. 

Testing and treatment for macular degeneration

Medicare Part B covers 80 percent of the costs for diagnostic tests and treatments, including those with certain injectable drugs, for eye disease if you have been diagnosed with age-related macular degeneration. Beneficiaries are responsible for the remaining 20 percent and Part B deductibles. If the testing or treatments take place in an outpatient hospital setting, you also pay a copayment. 

How much do routine eye exams cost without insurance coverage?

Costs vary according to location, physician, and type of exam. But for routine refractive exams, prices typically range between $50.00 and $250.00. The national average cost for an eye exam is approximately $95.00. 

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