Your exam may be covered by a vision plan or by your regular medical plan. If it is a routine anual exam your vision plan will apply. If it is a visit for any non routine concern your medical plan will apply.

Non routine examples are infections, dry eyes, headaches, pain, finding anything other than a glasses prescription change. Medicare also will help out if we find cataracts, retina issues, infections, etc. The part where we are checking your glasses prescription is called refraction It is never covered by medical insurance or medicare. This is because it is considered by insurance to be a routine procedure not related to a medical issue that has developed.

Once your deductible has been met, Medicare will cover an office visit or comprehensive exam for any medical complaint relating to the eye or visual system. Medicare also offers coverage for examinations if you have a diagnosed systemic disorder with established risk to eye health. In addition the majority of additional testing that may be required may be covered by Medicare with the appropriate diagnosis. Coverage may differ between individual plans.

Refraction (determining the prescription for glasses) and the glasses and/or contact lenses themselves are typically an out-of-pocket expense, or covered by a Medicare Advantage plan.