Does Medicare Cover Refraction?
A refraction eye exam is an exam that determines whether you have refractive vision errors that can cause nearsightedness, farsightedness, astigmatism, or a combination. Refraction exams are done by optometrists or ophthalmologists by shining a light into your eyes using a phoropter. When this light enters your eyes, it bends and reflects on the back of your eye (your retina). The position where it hits your retina shows the doctor whether you have refractive errors, what they are, and if you need prescription lenses to correct them.
Refraction exams are typically done as part of a routine visit for vision care to determine whether you need glasses or a change in your prescription. Your ophthalmologist might also find other vision issues during these exams like cataracts or age-related macular degeneration. Original Medicare does cover routine vision care or refraction exams for prescription changes.
Fortunately, Medicare Advantage plans may offer vision care services that include refraction exams and prescription lenses.
Does Original Medicare cover refraction exams?
Unfortunately, Original Medicare Part B does not cover routine eye examinations like refractions when you need to get checked for eyeglasses or contact lenses. Because of this, you must pay 100 percent of the cost of your examinations as well as for your glasses or contacts.
On the other hand, Original Medicare Parts A and B cover vision care services for medical conditions such as the following:
- Cataract surgery and one pair of corrective lenses after the procedure
- Examinations and prescription medications administered by a health care provider if you have macular degeneration
- Periodic eye exams for people with diabetes at risk for retinopathy
- Periodic screenings for people at risk for glaucoma to diagnose and treat the condition
How Medicare Advantage plans may cover vision care
If you have a Medicare Advantage (Part C) plan as an alternative to Original Medicare coverage, your plan may include benefits for routine vision care services. Because Medicare Advantage plans are sold by private insurance companies that are affiliated with Medicare, providers have the option to include extra benefits along with all benefits covered by Original Medicare Parts A and B.
Today, many Medicare Advantage plans provide extended vision care services that include refraction exams as well as eyeglasses or contact lenses. Depending on the plan you have, you may be limited to a certain number of vision exams and pairs of glasses per year. Your plan may also require that you use health care providers and medical suppliers that are included in its network of providers.
How much you pay out-of-pocket for copayments, coinsurance, deductibles, and monthly premiums depends on your plan and your provider. Even if you have a Medicare Advantage plan, you are also responsible for paying the monthly premium for Medicare Part B.