Medicare Vision Coverage: What Original Medicare Pays for Your Eyes (and What It Doesn't)

Original Medicare will pay to check your eyes for disease. It won't pay to check whether you need new glasses, and it won't buy the glasses. That split is written into federal regulation: 42 CFR 411.15(c) excludes eye exams "for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses," and 411.15(b) excludes eyeglasses and other lens devices, with narrow exceptions tied to cataract surgery and loss of the eye's natural lens.

So the question "does Medicare cover vision?" has two answers. For medical eye care (diabetic eye disease, glaucoma, macular degeneration, cataracts) Part B pays its usual 80% after the deductible. For routine vision care, you pay all of it unless you have other coverage. Here's exactly where the line falls, what it costs in 2026, and what Washington residents can use to fill the gap.

Source: CMS, 2026 Medicare Parts A & B premiums and deductibles; Medicare.gov, Eye exams (for diabetes); eCFR, 42 CFR 411.15. CMS had not announced 2027 amounts as of November 13, 2026.

Covered vs. not covered, at a glance

This is the table I'd keep on the fridge. The left column is the service; the right two tell you which part of Medicare (if any) pays and what you owe.

Source: Medicare.gov, Eye exams (routine); Eyeglasses & contact lenses; Eye exams (for diabetes); Glaucoma screenings; Macular degeneration tests & treatment; Cataract surgery; 42 CFR 411.15(b). In a hospital outpatient setting you also pay a facility copayment.

What Original Medicare won't pay for

Routine eye exams. Medicare.gov says it plainly: Medicare doesn't cover routine eye exams, "sometimes called 'eye refractions,'" for eyeglasses or contact lenses, and you pay all costs. The Medicare & You 2027 handbook lists "eye exams (for prescription eyeglasses and corrected contact lenses)" among the things Part A and Part B don't cover.

The refraction fee inside a covered visit. This is the one that surprises people. The regulation excludes refraction, the "which is better, one or two?" test that sets your lens prescription, "even when performed in connection with otherwise covered diagnosis or treatment." So if you see your eye doctor for a covered medical reason and they also measure you for glasses, expect a separate bill for the refraction. Medicare won't pay that line. Medigap pays toward your share of Medicare-covered care, and Medicare.gov says Medigap policies generally don't cover vision care or glasses.

Glasses, contacts and low vision devices. The exclusion in 42 CFR 411.15(b) is broad. It covers "all devices irrespective of their size, form, or technological features that use one or more lens to aid vision or provide magnification of images for impaired vision." That can reach handheld magnifiers and electronic magnifiers with lenses, not just eyeglasses.

If you have diabetes: the yearly retinopathy exam

Part B covers an eye exam for diabetic retinopathy once a year if you have diabetes, according to Medicare.gov. The exam has to be done by an eye doctor who's legally allowed to do the test in Washington (or whatever state you're in). After the Part B deductible, you pay 20% of the Medicare-approved amount for the doctor's services, plus a copayment if it's done in a hospital outpatient department.

Note what this exam is for: checking for diabetic eye disease. It isn't a glasses exam, so if the doctor also does a refraction at the same visit, that piece is billed to you, as explained above. Having diabetes also puts you in a high-risk group for glaucoma, which brings in a second covered test. Our guide to Medicare diabetes supplies covers the rest of what Part B and Part D pay for when you have diabetes.

Glaucoma screening: who qualifies

Glaucoma screening is a Part B preventive service, but only for people Medicare considers at high risk. Per Medicare.gov and the Medicare & You 2027 handbook, you qualify if at least one of these applies to you:

Source: Medicare.gov, Glaucoma screenings; Medicare & You 2027, Section 2; 42 CFR 411.15(a)(1) (glaucoma screening exams are an exception to the routine-checkup exclusion).

An eye doctor legally allowed to do glaucoma tests in your state must do or supervise the screening. Here's the detail that trips people up: many Part B preventive services cost you nothing, but this one doesn't work that way. Medicare.gov says that after the Part B deductible, you pay 20% of the Medicare-approved amount, and a copayment in a hospital outpatient setting. Our rundown of Medicare preventive services shows which screenings are no-cost and which aren't.

If you don't fit a high-risk group but your eye doctor finds a problem, such as high eye pressure or changes in the optic nerve, follow-up testing and treatment for a diagnosed condition are medical care, not a screening. That's billed to Part B as diagnosis and treatment.

Macular degeneration and other eye diseases

Age-related macular degeneration blurs or reduces central vision. Medicare.gov says Part B "may cover certain diagnostic tests and treatments (including treatment with certain injectable drugs)" if you have it. In most cases you pay 20% of the Medicare-approved amount for both the drug and your doctor's services after the deductible, plus a separate facility copayment in a hospital outpatient setting.

The injections matter for cost. Part B, not Part D, generally covers drugs a provider gives you in the office: Medicare.gov's Part B drug page says Medicare "covers most injectable and infused drugs when a licensed medical provider gives them." Because your share is a percentage of the drug's approved amount, a series of injection visits can add up fast. That's where secondary coverage, such as a Medigap policy or Apple Health, can matter, because it may pick up some or all of the 20%.

The same logic applies to other medical eye problems: an eye injury, an infection, sudden vision changes. Diagnosis and treatment of an illness or injury is medical care under Part B, even though the refraction part of the visit still isn't covered.

The one time Medicare pays for glasses: after cataract surgery

Part B may cover cataract surgery that implants a conventional intraocular lens, per Medicare.gov. After each such surgery, Part B covers one pair of eyeglasses with standard frames or one set of contact lenses, per Medicare.gov. You pay 20% of the Medicare-approved amount after the deductible. A few rules decide whether this benefit actually works for you:

• It's per surgery. Each cataract surgery with a lens implant gets its own pair. Two eyes done at different times means two covered pairs.
• Standard frames only. You pay any additional cost for upgraded frames.
• The supplier must participate in Medicare. Medicare will only pay for glasses or contacts from a participating supplier, whether you or your provider submits the claim. Ask before you order.
• No replacements. CMS's Benefit Policy Manual, chapter 15 says replacing those post-surgery glasses or contacts isn't covered. Lose them and you're back to paying full price.

If you're weighing a premium lens implant, our guide to Medicare cataract surgery coverage explains how Medicare handles those lenses and what the surgery itself typically costs under Part B.

What covered eye care costs you in 2026

Every covered eye service above runs through standard Part B cost sharing. For 2026, CMS set the Part B deductible at $283 (up $26 from 2025) and the standard premium at $202.90 a month. CMS normally announces the next year's figures in the fall. As of November 13, 2026, the CMS newsroom hadn't posted the 2027 Part B premium or deductible, and the Medicare & You 2027 handbook says those amounts "weren't available at the time of printing." I won't guess at them.

What you actually owe also depends on whether your eye doctor accepts assignment. Medicare.gov explains that providers who accept assignment charge you only the deductible and coinsurance; those who don't can charge more than the approved amount, in many cases up to 15% more. Our post on Part B excess charges in Washington goes into that.

Example (hypothetical, not real Medicare rates): Say you have diabetes and macular degeneration, and you haven't used any other Part B services in 2026. Your first visit is a diabetic eye exam with a Medicare-approved amount of $150. Then you have two injection visits, each with an approved amount of $1,000 for the drug and doctor combined, at a doctor who accepts assignment.

Source: deductible from CMS 2026 Parts A & B fact sheet; cost-sharing rules from Medicare.gov, Eye exams (for diabetes) and Macular degeneration tests & treatment. Approved amounts are made up for illustration. Office setting; no hospital outpatient copayment included.

• You pay
• Medicare pays

$0$250$500$750$1,000

ExamInjection 1Injection 2

Source: Calculation using the CMS 2026 Part B deductible and Medicare.gov Part B cost-sharing rules; amounts are illustrative only.

Show the numbers

	You pay	Medicare pays
Exam	$150	$0
Injection 1	$306	$694
Injection 2	$200	$800

The first $150 visit comes entirely out of your pocket because it all goes toward the deductible. On visit two, the remaining $133 of the deductible comes first, then 20% of the other $867. By visit three you're at a flat 20%. Total for the year so far: $656.40 out of pocket on $2,150 of approved care. Original Medicare has no yearly out-of-pocket cap, so that 20% keeps going for as long as treatment does, unless something else picks it up.

Eye drops and Part D

Prescription eye drops you pick up at a pharmacy, such as drops for glaucoma, generally fall under Medicare drug coverage (Part D), whether through a stand-alone drug plan or a Medicare Advantage plan that includes drug coverage. Each plan has its own list of covered drugs, called a formulary, per Medicare.gov, so check that your specific drops are on it.

The government sets the outer limits. Medicare.gov says no drug plan may have a deductible above $615 in 2026 ($700 in 2027). After that you pay 25% coinsurance until your out-of-pocket spending on covered drugs reaches $2,100 in 2026 ($2,400 in 2027). Then you pay nothing for covered Part D drugs for the rest of the year. Your plan's own copays may be lower. Our Washington Part D page explains how drug coverage fits with the rest of Medicare.

Source: Medicare.gov, How much does Medicare drug coverage cost? Individual plans set their own premiums and copays within these limits.

Medicare Advantage and Medigap: what changes, what doesn't

Medicare Advantage. Every Medicare Advantage plan has to cover everything Part A and Part B cover, under 42 CFR 422.101, so the diabetic eye exam, glaucoma screening, macular degeneration treatment and post-cataract glasses are all included, with the plan's own cost sharing. Beyond that, Medicare.gov says some plans "offer extra benefits that Original Medicare doesn't cover - like vision, hearing, or dental."

The word is "some." Extra vision benefits are optional, they differ from plan to plan, and they can change every January. If routine vision matters to you, read the vision section of a plan's Evidence of Coverage and look for:

• whether it covers a routine eye exam, eyewear, or both
• how often you can use it, and any dollar limit on frames, lenses or contacts
• whether you have to use a specific network of eye doctors or optical stores
• whether the extra benefit works like an allowance or like a discount

You can compare plans in the Medicare.gov plan finder or by calling 1-800-MEDICARE. I'd keep vision in perspective, though: your doctors, hospitals and prescriptions usually matter more over a year than a frame allowance. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027. If you're already in a Medicare Advantage plan, you get another chance to switch plans or go back to Original Medicare from January 1 to March 31. Our comparison of Medicare Advantage vs. Medigap in Washington walks through the bigger trade-offs.

Medigap. A Medicare Supplement policy generally doesn't add routine vision. Medicare.gov lists "vision or dental care" and "glasses" among the things Medigap plans generally don't cover. What Medigap does do is pay toward your share of covered care. Per Medicare.gov's plan comparison chart, most plan letters pay the full Part B coinsurance (Plan N with some copays; Plans K and L pay 50% and 75%), so the 20% on macular degeneration injections or a diabetic eye exam can shrink a lot. Our Washington Medicare Supplement page explains the plan letters.

Washington: Apple Health eye exams and where to get help

If you have Medicare and limited income in Washington, Apple Health (Medicaid) can cover what Medicare won't, at least for exams. HCA says any Apple Health coverage you have alongside Medicare works "as a secondary insurance to Medicare": Medicare pays first.

Under the benefit table in WAC 182-501-0060, the Classic Medicaid packages (Categorically Needy and Medically Needy) include "exams, refractions, and fittings" for adults. WAC 182-531-1000 sets the frequency: once every 24 months for adults 21 and older without symptoms, and more often when a provider is diagnosing or treating a condition with vision symptoms, when you take medication that affects vision, or (with prior authorization and at least 18 months since your last exam) when your glasses or contacts are lost or broken.

Glasses are a different story. The same benefit table says frames and lenses are not included for adults 21 and over, and HCA's vision care page confirms "eyeglass frames and lenses are not covered" for adults. HCA says adults can buy frames and lenses at a discounted price through its vision hardware contractor at participating optical providers.

Source: Medicare.gov, Eye exams (routine); Medicare.gov, What Medigap covers; WAC 182-501-0060; WAC 182-531-1000; HCA, Can I get vision care?; HCA, Medicare Savings Program.

That last row matters. HCA's Medicare Savings Program page lists what each program pays: QMB covers Part A and B premiums, deductibles and copayments (except for prescriptions); SLMB and QI-1 pay the Part B premium. An MSP approval letter by itself doesn't give you Apple Health's eye exam benefit. QMB does help with the medical side, though, because it pays the Part B deductible and cost sharing on covered eye care. Apple Health questions go to HCA at 1-800-562-3022.

For a free, unbiased look at your whole situation, call SHIBA, the Office of the Insurance Commissioner's Medicare counseling program, at 1-800-562-6900. Our guide to SHIBA explains how it works. Dental follows a similar "routine care isn't covered" rule; see our Medicare dental coverage guide. More on Medicare in Washington is on our Washington Medicare page.

What to do with this

1. If you have diabetes, get the yearly retinopathy exam. It's a Part B service, and it's also one of the risk factors that qualifies you for the glaucoma screening.
2. Check whether you're in a glaucoma high-risk group (family history, African American and 50+, Hispanic and 65+, diabetes). If you are, ask for the covered screening once every 12 months.
3. Ask about the refraction fee before any eye appointment, and get the self-pay price.
4. After cataract surgery, order your covered glasses or contacts from a supplier that participates in Medicare, and decide whether an upgraded frame is worth paying the difference.
5. Check your eye drops against your Part D plan's formulary before January 1.
6. If routine vision is a priority, compare Medicare Advantage plans' extra vision benefits in the plan finder, or budget for exams and glasses out of pocket alongside Original Medicare.
7. If money is tight, see whether you qualify for full Apple Health, not just a Medicare Savings Program.

FAQ

Does Medicare cover eye exams?

Original Medicare doesn't cover routine eye exams (refractions) for glasses or contacts. Part B does cover a yearly diabetic retinopathy exam if you have diabetes, glaucoma screening once every 12 months for people at high risk, and tests and treatment for eye diseases like macular degeneration.

Does Medicare pay for glasses?

Usually not. The exception: Part B covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants an intraocular lens. You pay 20% of the Medicare-approved amount after the Part B deductible, plus any cost for upgraded frames.

Who qualifies for a Medicare glaucoma screening?

People at high risk: those with diabetes, a family history of glaucoma, African Americans 50 or older, and Hispanic people 65 or older. Part B covers it once every 12 months, and you pay 20% of the Medicare-approved amount after the deductible.

Does Medigap cover vision?

Generally, no. Medicare.gov lists vision care and glasses among the things Medigap plans generally don't cover. Medigap can pay toward your 20% share of eye care that Original Medicare covers, such as macular degeneration treatment.

Federal Medicare rules, your own plan or policy documents and Washington law control what's covered. Confirm your situation with Medicare, SHIBA, HCA or a licensed agent before you schedule care or buy eyewear.

Sources

1. Medicare.gov: Eye exams (routine)
2. Medicare.gov: Eyeglasses & contact lenses
3. Medicare.gov: Eye exams (for diabetes)
4. Medicare.gov: Glaucoma screenings
5. Medicare.gov: Macular degeneration tests & treatment
6. Medicare.gov: Cataract surgery
7. Medicare.gov: Prescription drugs (outpatient), Part B
8. Medicare.gov: Does your provider accept Medicare as full payment?
9. Medicare.gov: How much does Medicare drug coverage cost?
10. Medicare.gov: What do drug plans cover?
11. Medicare.gov: What Medigap covers
12. Medicare.gov: Compare Medigap plan benefits
13. Medicare & You 2027 handbook
14. Medicare.gov plan finder
15. eCFR: 42 CFR 411.15, particular services excluded from coverage
16. eCFR: 42 CFR 422.101, requirements relating to basic benefits
17. CMS Medicare Benefit Policy Manual, chapter 15 (§120)
18. CMS MLN006266: Medicare Advance Written Notices of Non-coverage
19. CMS: 2026 Medicare Parts A & B premiums and deductibles
20. CMS newsroom
21. WAC 182-531-1000: Ophthalmic services
22. WAC 182-501-0060: Program benefit packages
23. HCA: Can I get vision care?
24. HCA: Age 65 and older or Medicare eligible
25. HCA: Medicare Savings Program
26. Washington OIC: Get free Medicare help from SHIBA