Does Medicare Cover Scleral Lenses?

Scleral lenses, although innovative and beneficial for various eye conditions, are typically not covered by Medicare. However, exceptions exist, and it’s essential to understand the circumstances under which Medicare might provide coverage for these specialized lenses. In this article, we’ll explore what scleral lenses are, how they work, their benefits, and the current status of Medicare coverage. Additionally, we’ll delve into alternative options and offer guidance on obtaining affordable scleral lenses.

Understanding Scleral Lenses

Scleral lenses are custom-made contact lenses designed to rest on the white part of the eye, known as the sclera. Unlike traditional contact lenses that sit on the cornea, scleral lenses provide a comfortable fit and are particularly useful in treating conditions such as dry eyes, keratoconus, and post-surgical complications.

These lenses work by vaulting over the entire corneal surface, creating a tear-filled space between the lens and the eye. This unique design helps maintain corneal hydration, offering improved comfort and stability for individuals with complex eye conditions.

Benefits of Scleral Lenses

The use of scleral lenses offers several advantages, making them a preferred option for individuals with specific eye issues. Firstly, they provide better vision and comfort, addressing the challenges posed by conditions like keratoconus. Moreover, the vaulted design acts as a protective barrier, shielding the cornea from dust and debris, reducing the risk of infections and irritations. Additionally, scleral lenses can alleviate symptoms such as dryness and light sensitivity, enhancing the overall eye care experience.

Medicare Coverage for Scleral Lenses

As of now, Medicare does not typically cover scleral lenses. However, there are exceptions. If a qualified eye care professional deems scleral lenses medically necessary for your condition, Medicare might provide coverage. It’s crucial to consult with your doctor to determine whether your specific case qualifies for such an exception.

Furthermore, some Medicare Advantage plans may offer coverage for scleral lenses. These plans often include additional vision benefits beyond what original Medicare provides. To ascertain whether your Medicare Advantage plan covers scleral lenses, contact your plan provider and inquire about available vision coverage options.

It’s essential to note that coverage policies can vary among different Medicare Advantage plans, so it’s advisable to review your specific plan details to understand the extent of coverage for scleral lenses.

Getting a Prescription for Scleral Lenses

If you believe scleral lenses are suitable for your vision needs, start by scheduling a comprehensive eye exam with an optometrist or ophthalmologist. Following the examination, your eye care professional can provide a prescription for the appropriate type of scleral lens based on your unique requirements.

The next step involves a fitting with an experienced contact lens specialist. Given that scleral lenses are custom-made, a precise fit is crucial for optimal vision and comfort. During the fitting process, your eye care professional will measure your eyes, assess your vision needs, and make necessary adjustments to ensure the lenses fit perfectly.

Affordable Options for Scleral Lenses

While Medicare coverage for scleral lenses might be limited, there are alternative ways to make them more accessible and affordable. Many eye care centers offer discounts and payment plans, making these lenses more financially viable. Additionally, inquire with your provider about any accepted insurance or discount programs that could help reduce the cost of scleral lenses.

For those seeking more budget-friendly options, some online retailers offer scleral lenses. However, exercise caution and ensure that the lenses are of high quality and properly fitted by a qualified eye care professional to avoid any complications.


In conclusion, while Medicare typically does not cover scleral lenses, exceptions exist, and coverage may be available under certain circumstances or through specific Medicare Advantage plans. To determine the best course of action for your vision needs, engage in open communication with your eye care provider. Scleral lenses, with their unique design and benefits, can be a transformative solution for individuals with specific eye conditions, and exploring all available options will help you make informed decisions regarding your eye care. Remember, this content is for informational purposes only, and for questions about your Medicare plan, reach out to The Mair Agency today!

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