Yes, Medicare covers eye exams for diabetic retinopathy once every 12 months if you have diabetes. The exam falls under Part B, and after meeting your annual deductible, you’ll pay 20% of the Medicare-approved amount. But the details matter: what’s covered, what’s not, and what additional eye care you qualify for as a diabetic patient can save you real money.
What Medicare Part B Covers
Medicare Part B specifically covers a dilated eye exam to check for diabetic retinopathy, the condition where high blood sugar damages the tiny blood vessels in your retina. You’re eligible as long as you have a diabetes diagnosis. There’s no requirement that you show symptoms or that a previous exam found problems. The exam must be performed by an eye doctor (ophthalmologist or optometrist) who is legally authorized to do the test in your state.
You can get this exam once every 12 months. The clock resets based on the date of your last covered exam, not the calendar year, so keep track of when you went.
Your Out-of-Pocket Costs
In 2026, the Part B annual deductible is $283. Once you’ve met that deductible through any Part B services during the year, you pay 20% of the Medicare-approved amount for the diabetic eye exam. If you haven’t yet hit your deductible, the full cost of the exam applies toward it.
For context, a dilated retinal exam typically runs between $100 and $250 at the Medicare-approved rate, so your 20% share after the deductible would likely fall in the $20 to $50 range. If your eye doctor accepts assignment (meaning they accept Medicare’s approved amount as full payment), you won’t be billed beyond that 20%.
Glaucoma Screening Is Also Covered
Because you have diabetes, Medicare considers you high risk for glaucoma. That qualifies you for a separate glaucoma screening once every 12 months, also under Part B. The same cost-sharing applies: 20% coinsurance after your deductible. If you get the screening at a hospital outpatient facility rather than a private office, you’ll also pay a facility copayment.
This screening can often be done during the same visit as your diabetic retinopathy exam, so ask your eye doctor to combine them. You’ll still be billed for each service separately, but you save yourself a second trip.
What Medicare Does Not Cover
Medicare draws a firm line between medical eye exams and routine vision care. A diabetic retinopathy exam is medical. A routine eye exam to update your glasses or contact lens prescription is not. Medicare pays nothing for routine refractions, and you’re responsible for 100% of that cost.
Medicare also does not cover eyeglasses or contact lenses under normal circumstances. There is one exception: after cataract surgery that implants an intraocular lens, Part B covers one pair of glasses with standard frames or one set of contact lenses. You pay 20% after the deductible, plus any costs for upgraded frames.
If Your Exam Finds a Problem
When a diabetic eye exam reveals retinopathy or another condition needing treatment, Medicare Part B covers the follow-up care. This includes diagnostic tests, laser treatments, and injectable medications used to stop abnormal blood vessel growth in the retina. The same 20% coinsurance applies to both the drug itself and your doctor’s services for administering it. If you receive treatment in a hospital outpatient setting, expect a separate facility copayment on top of the coinsurance.
Diabetic retinopathy often progresses without noticeable symptoms in its early stages, which is exactly why Medicare covers annual screening. Catching it early means treatment can prevent significant vision loss rather than trying to reverse damage that’s already happened.
Medicare Advantage Plans May Offer More
If you’re enrolled in a Medicare Advantage plan (Part C) instead of Original Medicare, your diabetic eye exam coverage carries over because Advantage plans must cover everything Original Medicare covers. But many Advantage plans add routine vision benefits on top of that, including coverage for annual refractions, eyeglasses, and contact lenses that Original Medicare excludes.
The specifics vary widely by plan. Some offer a fixed annual allowance for eyewear (commonly $100 to $250), while others cover routine eye exams with a small copay. If you’re comparing plans during open enrollment, check the vision benefit details carefully, because this is one area where Advantage plans can meaningfully reduce your total out-of-pocket spending.
Medigap policies, on the other hand, generally do not cover routine vision care. They help pay your share of costs for services Original Medicare already covers (like the 20% coinsurance on your diabetic eye exam), but they won’t add new vision benefits.
How to Make Sure Your Exam Is Covered
The most common reason a diabetic eye exam claim gets denied is a coding issue, not an eligibility problem. To avoid surprises, confirm a few things before your appointment. First, make sure your eye doctor accepts Medicare assignment. Second, let the office know at scheduling that you have diabetes and want the exam billed as a diabetic retinopathy screening, not a routine vision exam. The distinction in billing codes is the difference between Medicare paying its share and you paying the full bill.
If your eye doctor also checks your prescription for glasses during the same visit, that portion may be billed separately as a routine refraction, and Medicare won’t cover it. Ask upfront whether the office plans to split the billing so you know what to expect.