Routine eye exams and glasses
Medicare.gov says Original Medicare doesn't cover routine eye exams, sometimes called eye refractions, for eyeglasses or contact lenses, and doesn't usually cover glasses or contacts. You pay the full cost. A Medigap policy doesn't change that, because Medigap only helps with services Original Medicare covers.
Eye care Part B does cover
| Service | Who and how often |
|---|---|
| Glaucoma test | Once every 12 months if you're at high risk (diabetes, family history, African American 50+, Hispanic 65+) |
| Diabetic eye exam | Once a year if you have diabetes |
| Cataract surgery | When medically necessary, including the implanted lens |
| Glasses or contacts | One pair (or one set) after each cataract surgery with an intraocular lens |
For these services you pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026). In a hospital outpatient setting you also pay a copayment. Ask whether the eye doctor accepts Medicare assignment; see can I keep my doctor.
Medicare Advantage
Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage. If eyewear matters to you, ask which eye doctors and optical stores are in the plan's network. See Medicare Advantage in North Carolina.
NC Medicaid vision care for adults
If you have Medicare and full NC Medicaid, Medicare pays first for medical eye care, and NC Medicaid covers routine vision care under Clinical Coverage Policy 6B (amended May 1, 2024):
- Routine eye exam with refraction: once every two years, without prior approval.
- Eyeglasses: once every two years, with prior approval. Frames and lenses each follow the two-year rule.
- Where glasses come from: you choose a frame from NC Medicaid's selection, and the glasses are usually made by the DHHS optical laboratory contractor rather than the store.
MQB alone, North Carolina's Medicare Savings Program, pays Medicare costs and doesn't add vision care. To apply for NC Medicaid, use ePASS or your county Department of Social Services; the NC Medicaid Contact Center is 1-888-245-0179.
Get help
A licensed insurance agent who works with Benefits Life can explain vision options with Medicare and compare plans from the companies they work with, at no cost to you. You can request a call from a licensed insurance agent, or see plans for your ZIP code.
Related questions
Does Medicare cover hearing aids in North Carolina?
Exams yes, hearing aids no.
Does Medicare cover dental in North Carolina?
When it pays, and NC Medicaid dental.
How do I get rides to the doctor?
County DSS rides and more.
Sources
- Medicare.gov — Eye exams (routine)
- Medicare.gov — Glaucoma screenings
- Medicare.gov — Eye exams (for diabetes)
- Medicare.gov — Eyeglasses and contact lenses
- NC Medicaid — Clinical Coverage Policy 6B, Routine Eye Examination and Visual Aids for Beneficiaries 21 and Older (amended May 1, 2024)
- NC Medicaid — How to apply
More questions in this guide
- Can I keep my doctor when I go on Medicare in North Carolina?
- Does Medicare cover assisted living in North Carolina?
- Does Medicare cover dental in North Carolina?
- Does Medicare cover hearing aids in North Carolina?
- Does Medicare cover home health care in North Carolina?
- Does Medicare cover mental health care in North Carolina?
- Does Medicare cover nursing home care in North Carolina?
- How do I get rides to the doctor with Medicare in North Carolina?
Part of the guide: Medicare basics for North Carolinians · All questions
Frequently asked questions
Does Medicare pay for glasses after cataract surgery?
Yes. Part B covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants an intraocular lens. You pay 20% of the Medicare-approved amount after the Part B deductible, plus any extra cost for upgraded frames, and the supplier must participate in Medicare.
How often does NC Medicaid pay for an eye exam and glasses for adults?
Under NC Medicaid's Clinical Coverage Policy 6B, adults 21 and older can get a routine eye exam with refraction once every two years and eyeglasses once every two years. Glasses need prior approval, and an earlier exam or pair can be approved when vision changes significantly.
Who counts as high risk for glaucoma?
Medicare covers a glaucoma test once every 12 months if you have diabetes, have a family history of glaucoma, are African American and 50 or older, or are Hispanic and 65 or older. An eye doctor legally allowed to do the test in North Carolina must do or supervise it.
Medicare in your North Carolina county
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