Each time you need to purchase eyeglasses or contact lenses, you need to have an eye exam to determine your eye grade. Knowing your eye grade will help in finding the right eyeglasses or contact lenses for you. Another term for an eye exam before purchasing eyeglasses or contact lenses is called a refraction exam. 

So a common question many people have is, “does Medicare cover a refraction exam?” In this article, we answer that question in clear, plain English. You will also find the average costs of a refraction exam and other helpful info.

Does Medicare Cover a Refraction Exam?

The short answer is no. In most cases, Medicare will not cover the cost of a refraction exam before you get your contact lenses or eyeglasses. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your refraction exam. 

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for refraction exams. So that means you will have to pay 100 percent for your refraction exam before the construction of your contact lenses or eyeglasses. 

That is because most of the time, Original Medicare does not provide coverage for routine vision care. However, even though Original Medicare does not provide coverage for refraction exams and other routine eye services and care, they may provide coverage for some eye exams. But only if it is medically necessary. 

Original Medicare may provide coverage for eye exams if you:

  • Have diabetes
  • Require it for glaucoma
  • Need it for macular degeneration
  • Require it prior to your cataract surgery

If you have diabetes, Original Medicare will provide coverage for one eye exam in a year. This eye exam is called a diabetic retinopathy exam. If you are eligible for this type of eye exam, Medicare Part B covers 80 percent of the costs of your diabetic retinopathy exam. You will pay for the remaining 20 percent. 

Original Medicare also provides coverage for one eye exam a year for beneficiaries who are at high risk of developing glaucoma. You are considered at high risk if you:

  • Have a family history of glaucoma
  • Have diabetes
  • Are African American and at an age of 50 or older
  • Are Hispanic and at an age of 65 or older

If you have macular degeneration and you need an eye exam, Original Medicare will provide coverage for the costs. 

Part C Coverage for Refraction Exam

However, some Medicare Advantage plans (Medicare Part C) provide coverage for a refraction exam. Medicare Advantage plans must cover everything Original Medicare covers, though they also offer some additional benefits as well. However, coverage and out-of-pocket costs will vary depending on the plan you have. Many Medicare Part C plans provide coverage for routine vision care, which is why refraction exams before the construction of your contact lenses or eyeglasses are part of what they cover. 

How Much Does A Refraction Exam Cost?

Refractive vision tests usually cost around $50. This price will vary depending on the provider.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover mole removal?

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