Original Medicare does not pay for routine eye exams for glasses or contact lenses at any frequency. However, Medicare Part B does cover specific medical eye exams on a set schedule if you have diabetes, are at high risk for glaucoma, or have a diagnosed eye condition like macular degeneration. How often you’re covered depends entirely on which category you fall into.
Routine Eye Exams Are Not Covered
If you’re looking to get a standard eye exam to update your glasses or contact lens prescription, Medicare will not help with the cost. These exams, sometimes called “eye refractions,” are explicitly excluded from Part B coverage. You pay 100% out of pocket. This surprises many people who assume Medicare works like the employer insurance they had before age 65, but it’s one of the most consistent gaps in Original Medicare coverage.
Yearly Exams for Diabetes
If you have diabetes, Medicare Part B covers a dilated eye exam once every 12 months to screen for diabetic retinopathy, a condition where high blood sugar damages blood vessels in the back of the eye. This is one of the most straightforward eye benefits in Medicare: you have diabetes, you qualify, once a year.
The exam must be done by an eye doctor who is legally authorized to perform the test in your state, typically an ophthalmologist or optometrist. After you meet the Part B annual deductible ($257 in 2025), you pay 20% of the Medicare-approved amount. So if Medicare approves $150 for the exam, your share would be $30 after the deductible is met.
Glaucoma Screenings for High-Risk Groups
Medicare covers glaucoma screenings once every 12 months, but only if you’re considered high risk. You qualify if at least one of the following applies to you:
- You have diabetes
- You have a family history of glaucoma
- You’re African American and 50 or older
- You’re Hispanic and 65 or older
If none of those categories apply, Medicare won’t cover a glaucoma screening at all. If you do qualify, the same cost-sharing rules apply: you pay 20% of the approved amount after your Part B deductible. Glaucoma develops slowly and often without symptoms in its early stages, so this annual screening can catch damage before you notice any vision loss.
Macular Degeneration Tests and Treatment
For age-related macular degeneration, Medicare Part B takes a different approach. Rather than covering screenings on a fixed schedule, it covers diagnostic tests and treatments once you have a diagnosis. There’s no specific “once a year” rule here. Your doctor orders the tests they consider medically necessary, and Medicare evaluates whether to pay for them based on that medical justification.
Your cost is typically 20% of the Medicare-approved amount after the Part B deductible. If you receive treatment in a hospital outpatient setting, you’ll also pay a separate facility fee. Keep in mind that your doctor may recommend services more frequently than Medicare considers necessary, which could leave you with unexpected bills. It’s worth asking upfront whether a recommended test or treatment will be covered.
Medically Necessary Exams Have No Fixed Limit
Outside of the specific screening schedules above, Medicare Part B covers eye exams that are “medically necessary,” meaning a doctor orders them to diagnose or manage a specific problem. If you develop sudden vision changes, eye pain, flashes of light, or other new symptoms, an eye exam to investigate those symptoms is a medical visit, not a routine exam, and Medicare treats it accordingly.
There’s no hard cap on how often you can have medically necessary eye visits. The frequency depends on your condition and what your doctor documents as clinically appropriate. You’ll still pay the standard 20% coinsurance after your deductible, but you’re not limited to once a year the way screening benefits are.
Medicare Advantage May Cover More
Medicare Advantage plans (Part C) are required to cover everything Original Medicare covers, but many go further by adding routine vision benefits. This often includes a yearly eye exam for glasses or contacts, plus an allowance toward frames or lenses. The specifics vary widely by plan: some cover one routine exam per year with a small copay, others offer a set dollar amount toward eyewear.
If routine eye exams are important to you, comparing Medicare Advantage plans in your area is the most practical way to get that coverage. Check the plan’s evidence of coverage document for details on visit frequency, copay amounts, and any network restrictions for vision providers. These benefits can change from year to year, so it’s worth reviewing during open enrollment even if you’re already enrolled in a plan you like.