Does Medicare cover glasses and contact lenses?

The answer to the question "Does Medicare cover glasses?" is usually a big ol' "No." But before you shell out money for your new specs — or your new contact lenses, for that matter — there are some exceptions to be aware of. Here's what Medicare experts and eye doctors want you to know about getting coverage for your eyewear.

Medicare vision coverage: What's actually covered?

Many people believe eye care is covered by Medicare, but unfortunately, basics, like routine eye exams, are excluded from coverage. "Medicare doesn't even cover the refraction fee, which is a test for glasses," says William McLaughlin, an optometrist at the Ohio State University Wexner Medical Center. Fortunately, you may not be left entirely in the dark. Through approved providers, Medicare does step up to cover some vision needs, including:

• Eye exams when vision symptoms could signal a medical condition

• Annual glaucoma tests for high-risk individuals, including those with diabetes or a family history

• Yearly retinopathy screening for people with diabetes

• Testing and treatment for macular degeneration

• Basic cataract surgery (matching vision in both eyes) and post-surgery corrective lenses

Of course, there may be exceptions. "If vision problems or blindness are a side effect or result of an underlying medical condition, then vision care may be covered by traditional Medicare," says Sandy Kemp, a registered Social Security analyst in Las Vegas. Additionally, Medicare would likely cover an eye exam if you had a specific medical complaint, says McLaughlin, noting that it's always wise to check your coverage first.

Does Medicare cover glasses?

"Medicare usually does not cover the cost of glasses," says ophthalmologist Ravi Goel, a spokesperson for the American Academy of Ophthalmology. The main exception is if you have Medicare Part B and need glasses after traditional or laser cataract surgery using basic intraocular lens implants.

Here's what you need to know when using Medicare to cover glasses after cataract surgery:

• Choose matching vision correction for both eyes: "20/20 vision, where one eye is nearsighted and the other is farsighted, is not covered by Medicare, as this procedure includes adding an extra lens to your eye," says Kemp. Most people choose farsightedness and get nonprescription readers to help make up the difference.

• Meet your Part B deductible: You'll still need to meet your Part B deductible, which is currently $257 a year.

• Select the right eyeglass provider: Medicare will only pay for glasses from a supplier enrolled in Medicare.

• Pay your share: You're responsible for 20% of the Medicare-approved amount for corrective lenses after each approved cataract surgery with an intraocular lens.

But there is a loophole of sorts: If you're having cataract surgery on both eyes, you can get two separate pairs of glasses covered through Medicare. However, timing is key. "You need to order — and receive — your first pair of glasses after your first eye surgery but before your second surgery," says Goel. If you wait until after both surgeries are done to order glasses, you'll be eligible for only one pair instead of two.

Keep in mind that Medicare covers only standard lenses and UV protection. "That means one pair of single-vision or bifocal. Any extras such as transitional lenses, non-scratch coatings, ultra-lightweight lenses and no-line bifocals are not covered," says Kemp. However, if deemed "medically necessary," there's a chance Medicare may cover certain customized eyeglasses.

Medicare will also cover glasses if you're aphakic, which means you were born without a lens or had a cataract removed without getting an artificial lens implanted. "These days, however, most people who have cataract surgery get an artificial lens," says McLaughlin. If you're aphakic, you can receive either bifocal lenses, separate glasses for far and near vision, or glasses for near vision paired with contact lenses for far vision.

Does Medicare cover contacts?

The same Medicare coverage rules for glasses apply to contact lenses, meaning they're typically not covered unless needed after cataract surgery with an intraocular lens. Post-surgery, Medicare will cover one set of contact lenses. "That means a one-year supply. That's it," says Kemp.

Aphakic? Medicare offers more extensive coverage: Contact lenses for far vision (plus frames for near vision) and replacement lenses when medically necessary.

What does Medicare Advantage cover?

Good news: Medicare Advantage has the same cataract surgery/corrective lenses benefit as Medicare, plus additional vision coverage, depending on eligibility. In fact, nearly 99% of Medicare Advantage (Part C) members have their eye exams and/or eyewear covered — no cataract surgery required. "Historically, all Medicare Advantage plans are very similar, but you should still make sure there's an allowance for the cost of glasses or contacts in the plan documents," says Kemp.

And while you're digging through the nitty-gritty, take a closer look at eye exam coverage too. "Many people assume their Medicare Advantage plan covers everything during an eye exam, but that's a common misunderstanding," says Kemp. "Dilation isn't covered, nor is any special testing. Basic testing only."

The bottom line on Medicare vision coverage

It’s important to do your homework and be aware of your coverage before heading to the eye doctor. Contacting a Medicare representative directly will help you better understand your benefits. "Many patients don't realize they're being upsold on extra features," says Kemp. "The basics often work just fine." Those enticing lens add-ons can quickly drive up your bill, so consider carefully what you actually need.

If you're eligible for Medicaid or VA benefits, check your vision coverage eligibility. If you have questions about your benefits, contact your state Medicaid office or Veterans Affairs medical center to walk you through your options.

FAQs

Do I need to meet any criteria for eyeglasses or contacts coverage through Medicare?

Yes. Medicare Part B covers one pair of glasses with standard frames — or one set of contact lenses — after each cataract surgery with an artificial lens.

Can I get reimbursed for contact lenses or glasses with Medicare?

Yes, but only after cataract surgery with an artificial lens — and only when you get them from a Medicare-enrolled supplier. Before Medicare pays its share, you'll need to meet your Part B deductible. After that, you'll pay 20% of the Medicare-approved amount for your corrective lenses, and Medicare will cover the remaining 80%.

How do I submit a claim for coverage?

You shouldn't have to. The law requires your doctor, provider or supplier to file Medicare claims on your behalf for covered services and supplies, including post-cataract surgery corrective glasses or contacts. However, if you paid out of pocket for your specs because your provider refused to submit a claim, you'll have to submit a claim on your own. Make sure to do so no later than 12 months after the date you received your lenses.

To file a claim, first download and fill out a CMS-1490S form. Next, gather three things: An itemized bill from your doctor, supplier or other health care provider; a letter explaining why you're submitting the claim instead of your provider; and any supporting documents you might need. If you need help, visit shiphelp.org to be connected to the State Health Insurance Assistance Program in your area.

What are alternative options for glasses or contact lenses coverage?

Beyond original Medicare, several paths can help with vision care costs. Veterans with service-connected disabilities, Purple Heart recipients or those meeting other service criteria may qualify for VA coverage. Vision benefits are also often available through Medicaid and Medicare Advantage plans. While stand-alone vision insurance is available, Kemp notes it "usually isn't worthwhile if you already have Medicare Advantage."

Meet our experts

• William McLaughlin, OD, an optometrist at the Ohio State University Wexner Medical Center

• Sandy Kemp, RSS, a registered Social Security analyst in Las Vegas

• Dr. Ravi Goel, a spokesperson for the American Academy of Ophthalmology and an ophthalmologist at Regional Eye Associates in New Jersey

Our health content is for informational purposes only and is not intended as professional medical advice. Consult a medical professional on questions about your health.