Medicare Benefits Coverage for Glasses for Diabetics

Generally, Medicare does not offer benefits for routine vision exams or exams needed to get a prescription for eyeglasses or contacts. Many Medicare recipients who want vision care included in their healthcare coverage choose to enroll in a Medicare Advantage (MA) plan.

MA plans are an alternative to Original Medicare. They are required to include at least the same Part A and Part B coverage of Original Medicare, but many plans include additional benefits, such as routine vision and dental care, prescription drug coverage, and fitness programs.

TIP: Did you know that you can use our plan finder to discover Medicare plans that include more of the diabetic vision care services you need? Or, call today to speak with a Licensed Sales Agent who can answer your Medicare questions: 877-882-1927.

Prevalence of Diabetes

Over the past few decades, the World Health Organization (WHO) has reported a steady increase in people with diabetes. According to WHO statistics, 422 million people worldwide had diabetes in 2014, up from 108 million in 1980, and the disease is a significant cause of blindness.

Screenings, treatment and lifestyle changes can help:

• Following a healthy diet
• Increased physical activity
• Prescribed medications
• Regular checkups including a diabetic eye exam

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Diabetes and Eye Problems

Diabetes is a chronic disease that prevents glucose (blood sugar) from entering the cells and providing fuel to the body. The pancreas produces insulin to drive this function.

The National Eye Institute explains that “the damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well.”

If you have diabetes, your eyes are at risk for blurry vision, cataracts, glaucoma, diabetic retinopathy and other eye diseases. WebMD reports that among adults ages 20 to 74, diabetes is the primary cause of blindness.

Symptoms of Diabetic Eye Diseases

A preventive vision screening is critical because you may not have any symptoms in the early stages of diabetic eye disease. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) outlines the symptoms you may experience at some point:

• Blurry or wavy sight
• Daily or frequency changes in your vision
• Loss of vision or areas that appear dark
• Reduced color vision
• Floaters (may appear as spots or strings floating in front or sides of your eyes)
• Light flashes

Diabetic Vision Care

If you have diabetes, Medicare Part B covers an annual exam for:

• Diabetic retinopathy
• Glaucoma

If you have diabetes, Medicare pays for diabetic vision exams up to 80% of the Medicare-approved amount. You are responsible for the 20% coinsurance and the Part B deductible ($233 in 2022).

If you do not have diabetes, you may still be eligible for glaucoma annual screenings if you:

• Have a family history of glaucoma OR
• Are at least 50 years old and African American OR
• Are age 65 or older and Hispanic

Does Medicare Cover Vision and Glasses?

The fact that Medicare covers a diabetic eye exam begs the question, “Does Medicare cover the cost of glasses for diabetics?” Medicare coverage of corrective eyewear is limited to those who have cataract surgery with intraocular lens implantation. To take advantage of this benefit, using a Medicare supplier is mandatory.

You are responsible for 20% of the Medicare-approved amount and the Part B deductible applies for corrective lenses you receive after these surgeries. If you want upgraded frames, you are responsible for paying any additional costs.

TIP: If you are looking for Medicare Advantage plans in your area that include glasses for adults, try our plan finder tool.