Routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare covers:
- Surgical procedures to help repair the function of the eye due to chronic eye conditions. For example, Medicare will cover surgery to remove a cataract and replace your eye’s lens with a fabricated intraocular lens.
- Eyeglasses or contacts if you had an intraocular lens placed in your eye after cataract surgery. In this case, Medicare will cover a standard pair of untinted prescription A prescription is an order for a health care service or drug written by a qualified health care professional. eyeglasses or contacts if you need them. If it is medically necessary Medically necessary refers to procedures, services, or equipment that meet accepted medical standards and are necessary for the diagnosis and treatment of a medical condition. , Medicare may pay for customized eyeglasses or contact lenses.
- An eye exam to diagnose potential vision problems. If you are having vision problems that may indicate a serious eye condition, Medicare will cover an exam. Your exam is covered even if it turns out you do not have a vision problem.
Medicare only covers routine eye care in the following circumstances:
- If you have diabetes, Medicare covers an annual eye exam by a state-authorized eye doctor to check for diabetes-related vision problems.
- If you are at high risk for glaucoma, Medicare covers an annual eye exam by a state-authorized eye doctor. 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, are Hispanic American and age 65+