What Does Medicare Not Cover: Vision Out-of-Pocket Costs

Medicare Bob
Medicare General Info
While routine eye exams or eyewear typically aren’t covered by Medicare, there are more serious eye conditions and procedures that can be covered.
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As a Medicare beneficiary, Original Medicare — Part A and Part B — has you covered for an array of services and procedures. However, it doesn’t cover everything a person might need in their health care journey.

Vision care coverage varies from service to service. While routine services may not be covered by Medicare, certain services for chronic conditions can be covered.

KFF.org found that more than a third, or 20.2 million, Medicare beneficiaries reported difficulty with their vision. With the lack of Medicare coverage for routine vision care, out-of-pocket costs can stack up for the millions of beneficiaries with eyesight issues. In fact, KFF.org’s study found that average out-of-pocket spending for vision care was about $230 per year.

What Vision Services Are Excluded From Medicare Coverage?

Some common vision care services that Medicare may not cover include:

  • Routine eye exams

  • Eyewear (e.g., eyeglasses, contacts)

Are There Any Exceptions to Medicare’s Vision Coverage?

If you have diabetes or are at high risk for glaucoma, Medicare can cover one annual eye exam to check for vision problems related to these diseases.

Medicare may also cover surgical procedures to repair any damage to your eyes made by a chronic condition, like cataracts. And after your cataracts surgery, Medicare can pay for any glasses or contacts you may need after the placement of an intraocular lens.

If you’re having vision problems that your physician believes could indicate a serious eye condition — like macular degeneration, you could be covered for an exam. Medicare can cover this exam even if your doctor determines you don’t have the suspected condition.

Medicare Advantage plans, Medicaid or insurance through a private plan may help you offset any out-of-pocket vision costs.

If you’re not sure about your vision coverage as a Medicare beneficiary and would like some additional help, call Senior Healthcare Direct at 1-833-463-3262, TTY 711 to talk to a licensed agent.

For more information on common Medicare out-of-pocket costs, check out the rest of the blogs in our “What Does Medicare NOT Cover?” series:

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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