Question and Answer

When does Medicare cover eye care?

Question: 
I recently had a cataract surgery and now I need new glasses. I heard that Medicare does not generally cover eye care. Will Medicare pay for any of this?

Answer:
Yes. Medicare will not generally pay for routine eye care, but it will pay for some eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare will cover:

  • Surgical procedures to help repair the function of the eye due to these conditions. For example, Medicare will cover surgery to remove the cataract and replace your eye’s lens with a man-made intraocular lens.
  • Eye glasses or contacts only if you have had cataract surgery during which an intraocular lens was placed into your eye. Medicare will cover a standard pair of untinted prescription eyeglasses or contacts if you need them after surgery. If it is medically necessary, Medicare may pay for customized eyeglass or contact lenses.
  • An eye exam to diagnose potential vision problems. If you are having vision problems that indicate a serious eye condition, Medicare will pay for an exam to see what is wrong, even if it turns out there is not anything wrong with your sight.

Medicare will only pay for routine eye care in the following specific circumstances:

  • If you have diabetes, Medicare will pay for an eye exam once every 12 months to check for vision loss due to the condition;

  • If you are at high risk for glaucoma Medicare will cover an eye exam by a state-authorized eye doctor once every 12 months. You are considered to be at high risk if you:
    • have diabetes;
    • have a family history of glaucoma;
    • are African American and age 50 or older; or
    • are Hispanic and age 65 or older.

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