Original Medicare does not cover routine eye exams for glasses or contact lenses. You pay the full cost out of pocket. However, Medicare Part B does cover specific medical eye exams tied to conditions like diabetes, glaucoma, and macular degeneration, and some Medicare Advantage plans include routine vision benefits that Original Medicare lacks.
The distinction comes down to why you’re getting the exam. A standard checkup to update your prescription? Not covered. An exam to monitor or diagnose a medical eye condition? Likely covered, as long as you meet certain eligibility criteria.
What Original Medicare Won’t Cover
Medicare explicitly excludes routine eye exams, sometimes called eye refractions, when the purpose is to prescribe eyeglasses or contact lenses. It also won’t cover the glasses or contacts themselves in most situations. If you’re on Original Medicare (Parts A and B) and you go in for a standard vision checkup, you’ll pay the entire bill yourself.
This surprises many people who assume basic vision care is part of the program. It isn’t. Medicare was designed primarily around medical necessity, and a routine prescription check doesn’t meet that threshold under current rules.
Eye Exams Medicare Does Cover
Part B covers eye exams that are medically necessary to detect or manage specific conditions. The three main categories are diabetic eye exams, glaucoma screenings, and testing for age-related macular degeneration.
Diabetic Eye Exams
If you have diabetes, Medicare covers a dilated eye exam once every 12 months to check for diabetic retinopathy and other diabetes-related eye damage. The exam must be performed by an eye doctor who is legally authorized to do the test in your state. After you meet the Part B annual deductible ($257 in 2025), you typically pay 20% of the Medicare-approved amount.
Glaucoma Screenings
Medicare covers an annual glaucoma screening, 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 you meet any of those criteria, you can get one screening every 12 months. The same cost-sharing applies: after your Part B deductible, you pay 20% of the approved amount.
Macular Degeneration Tests and Treatment
Part B may cover diagnostic tests and certain treatments if you have age-related macular degeneration, including treatment with injectable medications. In most cases, after meeting the deductible, you pay 20% of the Medicare-approved amount for the drugs and your doctor’s services. If you receive treatment in a hospital outpatient setting, there’s also a separate facility copayment.
The One Time Medicare Pays for Glasses
There is exactly one scenario where Original Medicare covers eyewear. After cataract surgery that includes implanting an intraocular lens, Part B covers one pair of eyeglasses with standard frames or one set of contact lenses. This applies after each qualifying cataract surgery, not as a general benefit. Outside of this situation, you’re on your own for glasses and contacts.
The coverage is limited to standard frames. If you want upgraded frames or premium lens features, you’ll pay the difference.
How Medicare Advantage Plans Differ
Medicare Advantage plans (Part C) are required to cover everything Original Medicare covers, but many go further by adding routine vision benefits. This can include annual eye exams for glasses, allowances toward frames and lenses, and sometimes discounts on contact lenses.
The specifics vary widely from plan to plan. Some offer a generous annual vision allowance, while others provide only a basic exam. If routine eye care is important to you, comparing the vision benefits across available Medicare Advantage plans in your area is worth the time. You can review plan details during open enrollment each fall.
What Medigap Plans Cover
Medigap (Medicare Supplement) policies help pay your share of costs for services that Original Medicare already covers, like the 20% coinsurance on a diabetic eye exam. They do not add new benefits. Since Original Medicare doesn’t cover routine eye exams, Medigap won’t cover them either. If you have a Medigap plan and want routine vision coverage, you’d need to purchase a separate standalone vision plan or switch to a Medicare Advantage plan that includes it.
Your Out-of-Pocket Costs for Covered Exams
For the eye exams that Part B does cover, your costs follow the standard Part B structure. In 2025, the annual Part B deductible is $257. Once you’ve met that deductible for the year, you pay 20% of whatever Medicare approves for the service. So if Medicare approves $150 for a diabetic eye exam and you’ve already met your deductible, your share would be $30. If you haven’t met the deductible yet, you’d pay more upfront until that $257 threshold is reached across all your Part B services for the year.
For covered telehealth visits, you pay the same amount you would for an in-person appointment. Medicare currently covers telehealth services through the end of 2027, including visits from your home anywhere in the U.S. Whether a specific eye-related consultation qualifies for telehealth depends on the service and your provider, so it’s worth asking when you schedule.