Medicare’s coverage for vision services is typically limited to people who have certain health conditions, like diabetes. Here’s how to qualify for a refraction exam.
If you visit your optometrist or ophthalmologist for a new corrective lens prescription, they will perform something called a refraction exam. This vision test helps determine if there’s a problem with the way light travels through your eye, which can lead to farsightedness, nearsightedness, astigmatism, or presbyopia.
By performing this exam, your provider can determine if you need corrective lenses or a change in your current prescription, and in some cases, they can diagnose the presence of certain eye diseases or disorders.
A refraction exam is commonly part of annual eye exams, and in these cases, Original Medicare may not cover the costs. However, some Medicare plans may cover eye exams in certain circumstances. Read on to learn more.
What is refraction?
Refraction refers to how light bends as it travels through the cornea and lens of your eye. If you have a refractive error, the light can’t properly focus on your retina due to the shape of your eye.
Refractive errors can lead to eye issues like astigmatism (blurriness and distortion of both distant and close objects), farsightedness (blurry close up), nearsightedness (blurry distance), or presbyopia (blurry close-up vision associated with age).
If you have refractive errors, it can typically be corrected by corrective lenses, like eyeglasses or contact lenses.
What is a refraction test?
A refraction test allows an eye doctor to determine if you have a refractive error, and what type and power of corrective lens is needed to correct that error.
Usually, the provider will place something called a phoropter in front of your eyes. They will ask you to look into the device and read a series of letters displayed on a screen or the wall across the room. The provider will flip through different strengths of lenses inside the device that will make the letters more blurry or clearer.
During this time, and using a device called a retinoscope, the provider will measure and determine how each lens affects your eyes. This will help tell them what the prescription for your corrective lenses should be.
Is a refraction test necessary?
The American Academy of Ophthalmology recommends that everyone aged 65 years and older undergoes an eye exam at least once per year, and during this exam, a refraction test will typically be performed.
A refraction test is one of the primary ways a provider can determine the prescription you may need for corrective lenses so you can see clearly. Otherwise, you may have blurred vision, headaches, difficultly doing daily tasks, and more. Plus, refraction errors get worse over time, leading to changes in prescriptions, so you must get regular exams to ensure you have the correct prescription for your lenses.
Additionally, if you have diabetes or other eye conditions, refraction testing can help your provider monitor any changes in your vision that might mean you need modifications to your treatment.
Most eye conditions don’t have symptoms in the early stage, so it’s important to have regular exams to stay proactive with your eye care and health.
Medicare coverage of refraction exams
Typically, refraction is considered part of a routine eye exam. In most cases, Original Medicare does not cover routine or annual eye exams; therefore, refraction tests would not be covered.
Medicare also does not cover the cost of glasses or contacts should you need them due to a refractive error in your eyes.
That said, if you have diabetes, Medicare Part B will typically cover one routine eye exam per year. In this case, because refraction is typically included in a routine exam, Part B is likely to cover it (as long as you choose a provider who is licensed to perform the test in your state).
Other Medicare vision care coverage
While Medicare typically doesn’t cover routine eye exams, it does provide other vision coverage in some situations.
For example, if you have diabetes, Medicare Part B will cover eye exams for diabetic retinopathy once per year. Medicare Part B also covers glaucoma screenings once every 12 months if you’re at high risk for developing the eye disease glaucoma (such as if you have a family history of glaucoma).
Medicare will also typically cover traditional cataract surgeries, laser cataract surgeries, and specific lens implants, as well as eyeglasses or contact lenses if you have cataract surgery that implants an intraocular lens.
Finally, Part B may help cover tests and treatment of eye diseases and conditions if you have age-related macular degeneration.
Do Medicare Advantage plans cover refraction?
Medicare Advantage plans (Part C) must provide at least the same benefits and coverage as Original Medicare. So, if you’re diabetic, your plan must also cover one routine eye exam per year (which would include refraction).
One major benefit to Medicare Advantage plans is that they provide additional coverage for things like vision, hearing, dental, and more. Depending on your plan, it may cover one routine eye exam per year for all beneficiaries. Because refraction is typically part of the routine eye exam, this test would likely be covered.
Your plan may also provide vision benefits for other vision services, like coverage for corrective lenses. Check with your plan to learn more about the vision care it covers.
If you’d like to find a Medicare plan that covers vision services, our Find a Plan tool makes it easy. Just enter your zip code to review plan benefits and costs.
How much does a refraction test cost?
If you are paying for an eye exam that includes a refraction test, it can be helpful to know what your out-of-pocket costs will be.
The cost of an eye exam with a refraction test depends on factors like which eye doctor you choose, where you live, and what other tests are performed. However, the average cost of an eye exam without insurance is about $184 (though it ranges from $50 to $250 or more). If your eye exam is not covered, you’d pay this cost 100% out-of-pocket.
If Medicare Part B covers your eye exam, you will pay 20% of the Medicare-approved amount. The Part B deductible also applies.
If you have a Medicare Advantage plan, you may be responsible for a co-pay or co-insurance, but your costs vary depending on your plan.