Original Medicare does not cover routine eye care, including regular eye exams. But what if you need an eye exam for diagnosing a cataract or serious vision problems?
So a common question many people have is, “does Medicare cover eye exams for cataracts?” In this article, we answer that question in clear, plain English. You will also find the average costs of eye exams for cataracts, as well as other helpful info.
Does Medicare Cover Eye Exams For Cataracts?
The short answer is yes; Medicare will cover the cost of eye exams for cataracts. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your eye exams for cataracts. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for eye exams for cataracts. Even though Original Medicare does not provide coverage for regular eye exams, it provides coverage for both preoperative eye exams and postoperative eye exams before a cataract-removal surgery.
Original Medicare also provides coverage for an eye exam to diagnose serious vision problems. Even if it turns out that you do not have a visual problem, Medicare will still cover it.
Coverage for eye exams for cataracts is provided by Medicare Part A if you receive the service in an inpatient setting. Medicare Part A will also provide coverage for cataract surgery if it takes place in an inpatient setting.
On the other hand, coverage for eye exams for cataracts is provided by Medicare Part B if you receive the service in an outpatient setting. Most of the time, Medicare Part B provides coverage for cataract removal surgery if it takes place in an outpatient setting.
Aside from preoperative and postoperative eye exams and the surgery itself, Medicare Part B also provides coverage for the following after a cataract removal surgery:
- The implantation of intraocular lens (IOL). Medicare Part B will not provide coverage for all types of IOL.
- Purchase of one pair of corrective eyeglasses. Medicare Part B will provide coverage for another pair of eyeglasses if you undergo a cataract removal surgery for your other eye later in your life.
Part C Coverage for Eye Exams for Cataracts
Medicare Advantage plans (Medicare Part C) also provide coverage for eye exams for cataracts. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan.
How Much Do Eye Exams Cost?
The average cost of an eye exam is $114. However, some clinics charge less than that, even going as low as $50. One of the factors that may affect the total costs of an eye exam is the clinic and the location where you will have the eye exam.
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 wisdom teeth?