Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. covers an annual glaucoma test if you are at high risk, so be sure to 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 DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plans cover prescriptions medications that are needed for glaucoma treatments.
- Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). provide coverage for expanded vision care that Orginal Medicare (Part A and Part B) does not.
- MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. policies are available for purchase to assist with the out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. 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 ChargesA Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment., 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 AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. 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 MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.. Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds..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
- DeductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.
- CoinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.
- CopaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.
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 visitMedicare's annual wellness visit is a preventative care service provided to its beneficiaries at no cost. The annual wellness visit is available every twelve months after the beneficiary's initial "Welcome to Medicare" preventative 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