Medicare Part B covers an annual glaucoma test if you are at high risk, so discuss your risk factors with your doctor during your annual wellness exam. Medicare Part B also covers glaucoma medications and treatments, including eye drops, certain laser treatments, and eye surgeries.
Key Takeaways
- Glaucoma is caused by a group of eye conditions that gradually damage a person’s vision.
- Vision loss from glaucoma is permanent, so early detection and preventive treatments are paramount to prevent further damage.
- Medicare Part B covers a glaucoma screening once per twelve-month period if you are at high risk for developing glaucoma.
- Medicare Part B covers laser therapy, eye surgeries, and post-surgery eye drops for beneficiaries with glaucoma.
- Medicare Part D plans cover prescriptions medications that are needed for glaucoma treatments.
- Medicare Advantage plans provide coverage for expanded vision care that Orginal Medicare (Part A and Part B) does not.
- Medigap policies are available for purchase to assist with the out-of-pocket costs of glaucoma treatments covered by Medicare.
What Is Glaucoma?
Glaucoma is a group of eye conditions that cause damage to the optic nerve. The damage is generally the result of abnormally high pressure in your eye. It is one of the leading causes of blindness in people over the age of 60.1Mayoclinic.org, “Glaucoma“, Accessed November 3, 2021
Vision loss due to glaucoma can’t be recovered. For this reason, it’s important to have regular eye exams that include measurements of your eye pressure. Early detection and treatment are the keys to slowing or preventing vision loss.1Mayoclinic.org, “Glaucoma“, Accessed November 3, 2021
How Does Medicare Cover Glaucoma?
Medicare Part B covers the cost of glaucoma screening once a year but only if you’re at high risk. You’re considered high risk for glaucoma if you:2Medicare.gov, “Glaucoma tests“, Accessed November 3, 2021
- Have diabetes
- Have a family history of glaucoma
- Are African American and 50+ years old
- Are Hispanic American and 65+ years old
If you fall into the risk factors above, Medicare covers glaucoma screening as long as it’s performed by an eye doctor or an eye doctor supervising someone who is performing the exam.
If the glaucoma test is performed in a hospital, you will have to pay the copayment.
Prescription Medications
Medicare Part D plans cover most prescription medications suitable for glaucoma treatment, including post-surgery pain medication, antibiotics, and eye drops. Depending on the Part D plan, members may pay an annual deductible, before the plan begins paying its share, as well as a co-payment with each prescription.3Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 15, 2021
Popular glaucoma medications include:
- Xalatan (latanoprost)
- Istalol (timolol)
- Timoptic (timolol)
- Alphagan P. (brimonidine)
- Cosopt (dorzolamide / timolol)
- Trusopt (dorzolamide)
- Lumigan
How Much Does Glaucoma Treatment Cost?
The cost of glaucoma treatments varies by area and the type of treatment used, with laser surgery costs ranging from $1,000 to $2,000 without coverage. After you have met your annual Medicare Part B deductible, Medicare pays 80 percent of all approved treatments for glaucoma. If the surgeon charges Excess Charges, you will pay those out-of-pocket unless you have a Medicare Advantage plan or a Medigap policy that covers Part B Excess Charges.4nvisioncenters.com, “Glaucoma Surgery: Types, Costs & Success Rates“, Accessed November 12, 2021
Medicare Advantage
Medicare Advantage plans are required to cover the same services as Medicare Part A and Part B, in addition to any expanded services offered. That includes glaucoma treatment. However, a beneficiary’s out-of-pocket costs with a Medicare Advantage plan may be different than those with Original Medicare. Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and durable medical equipment.5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 12, 2021
Medigap
People with Original Medicare can purchase additional insurance, called Medigap, to help cover their Medicare out-of-pocket costs.  Medicare supplement insurance, as it is also known, is available through private insurance companies. A Medigap policy will cover some or all of the out-of-pocket costs associated with Medicare-approved glaucoma treatment services. These costs include:6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 12, 2021
- Deductibles
- Coinsurance
- Copayments
Summary
If you are diabetic and/or have a family history of vision problems, you should talk with your doctor during your next annual wellness visit. Just a little preventative care can save your vision down the line. If you are diagnosed with glaucoma, Medicare and Medicare Advantage plans will cover much of the costs for your treatment. If glaucoma or other vision problems are a growing concern for you, look into a Medicare Advantage plan in your area for routine vision care, eyeglasses, and other vision benefits not covered by Original Medicare.
Citations
- 1Mayoclinic.org, “Glaucoma“, Accessed November 3, 2021
- 2Medicare.gov, “Glaucoma tests“, Accessed November 3, 2021
- 3Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 15, 2021
- 4nvisioncenters.com, “Glaucoma Surgery: Types, Costs & Success Rates“, Accessed November 12, 2021
- 5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 12, 2021
- 6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 12, 2021