Medicare Part B, which functions as medical insurance, generally does not pay for routine vision services. This means the cost of standard eyeglasses, contact lenses, and eye exams meant purely for vision correction must be paid out-of-pocket. Coverage for glasses is limited to specific circumstances where the eyewear is deemed medically necessary as a prosthetic device following a covered surgical procedure. Part B is not structured to cover preventive or routine vision expenses.
Routine Vision Care Under Part B
Medicare Part B specifically excludes coverage for routine eye examinations (eye refractions) and the eyeglasses or contact lenses needed solely to correct refractive errors. These services are classified as routine vision care, which falls outside the scope of Original Medicare’s medical benefits. Beneficiaries are responsible for 100% of the cost for new prescriptions and the corresponding corrective lenses.
Part B does provide coverage for eye care when it is medically necessary to diagnose or treat a disease or condition. This includes annual glaucoma screenings for people at high risk, such as those with diabetes or a family history of the disease. Coverage is also provided for diagnostic tests and treatment for chronic conditions like diabetic retinopathy and age-related macular degeneration. If an eye exam is performed to check for a medical condition rather than to determine a new eyeglass prescription, Part B covers 80% of the Medicare-approved amount after the annual deductible is met.
Coverage Following Cataract Surgery
The primary exception to Part B’s exclusion of eyeglasses coverage occurs when lenses are required following cataract surgery that implants an intraocular lens (IOL). In this scenario, the corrective lenses—either conventional eyeglasses with standard frames or contact lenses—are classified as a prosthetic device. Part B covers one pair of these corrective lenses after each surgery.
This coverage is limited to one pair of lenses or contacts and must be obtained from a Medicare-enrolled supplier or physician. If the beneficiary chooses to upgrade to features like designer frames, anti-reflective coatings, or progressive lenses, they must pay the difference beyond the Medicare-approved amount for the standard item. After the Part B deductible is satisfied, the beneficiary is responsible for a 20% coinsurance of the Medicare-approved amount for the glasses or contact lenses.
The coverage applies whether the cataract surgery is performed on one or both eyes, and the glasses are intended to provide the best corrected vision post-procedure. Because the glasses are considered an integral part of the surgical recovery, they are covered despite the general policy against routine vision correction. The specific type of IOL implanted, such as a standard monofocal lens, determines eligibility for this post-operative coverage.
How Medicare Advantage Plans Provide Vision Coverage
Since Original Medicare (Parts A and B) offers minimal vision benefits, many beneficiaries turn to Medicare Advantage (Part C) plans for broader coverage. These plans are offered by private insurance companies that contract with Medicare to provide all Part A and Part B benefits, often bundled with extra services. Routine vision care, including coverage for glasses, is a common supplemental benefit offered by these plans.
Medicare Advantage plans offer coverage for annual routine eye exams and an allowance toward the purchase of frames and lenses or contact lenses. The specific dollar amount of the eyewear allowance and the frequency of use varies significantly between plans. Some plans may offer a flat allowance, such as an average of $160 annually, while others may cover lenses with a small copayment.
Beneficiaries should review the plan’s Summary of Benefits to understand the full scope of vision coverage, including any limitations on frame costs or requirements to use specific in-network providers. While these plans provide a solution for routine vision needs, they operate independently of the Original Medicare rules. They do not alter the Part B coverage for medically necessary eye care or the post-cataract surgery benefit.