Medicare Part B pays for annual preventive screening for glaucoma. There are several different tests for the condition.
Some types of glaucoma are treatable with medication, while others require surgery.
In this article, we describe glaucoma and explain eye exams. We then discuss coverage, eligibility, and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Glaucoma is a disease that damages the optic nerve at the back of the eye and can lead to vision loss and blindness. The condition may occur as a result of high pressure in the eye due to fluid buildup, and it is often hereditary.
There are three main types of glaucoma:
Primary open-angle glaucoma
This type of glaucoma may cause gradual vision loss. There are no typical signs or symptoms of the condition, and early diagnosis is only possible if a regular eye examination reveals it. However, the condition may improve with medication.
In this condition, the nerve becomes damaged despite normal fluid pressure in the eye. A person may notice their eyesight changing in the center of their vision.
This type of glaucoma is rare and develops quickly when fluid cannot drain from the eye. Symptoms include a headache, nausea, eye pain, and sudden loss of eyesight. The condition is a recognized medical emergency and requires surgery.
Anyone can get glaucoma. However, as there is a chance of inheriting the disease, anyone who has a blood relative with glaucoma is at a higher risk. Family members of a person with glaucoma may need to undergo screening for the disease.
Some groups appear to be more at risk than others of getting glaucoma. The at-risk groups include people who:
For a routine glaucoma examination, a doctor may use only two tests:
- Tonometry: This test measures fluid pressure behind the eye. A doctor numbs the person’s eye and uses a machine to apply a small amount of pressure.
- Ophthalmoscopy: For this test, a doctor uses drops to dilate the person’s pupil so that they can see the optic nerve.
However, for a detailed examination, a doctor may also do the following three tests:
- Perimetry: By using a light spot on different parts of a person’s peripheral vision, the doctor can map a person’s vision.
- Pachymetry: Doctors use this test to determine the thickness of a person’s cornea.
- Gonioscopy: After numbing the eye with drops, the doctor measures the area where the iris and cornea meet. The iris sits behind the cornea and has the pupil in its center.
Medicare Part B pays for preventive services, which include a screening test for glaucoma. If a person believes that they may be at risk of developing the disease, they can get a test every 12 months.
When medications are necessary for treatment, Medicare Part D pays for prescriptions.
People sometimes require surgery to treat glaucoma. Medicare Part A pays for many medically necessary surgeries.
However, Medicare does not pay for routine eye examinations that measure a person’s vision and determine their need for eyeglasses or contact lenses.
For glaucoma tests, a person must pay the Medicare Part B deductible and 20% of the Medicare-approved amount.
If the person needs medication, Medicare Part D or Medicare Advantage with drug coverage may help with costs. The out-of-pocket cost depends on the insurance company and may include a copayment for medications.
When surgery is necessary, it may be difficult to find out the exact costs beforehand because a person may need extra services. A person can try to determine the costs by:
- asking the doctor or hospital about the charges
- checking whether they can undergo the procedure as an outpatient
- finding out whether other insurance through work or a spouse may cover costs
A person may also pay a copayment for outpatient surgery. However, if a person needs to stay in the hospital for surgery, they will need to pay the Medicare Part A deductible. If a person stays in the hospital for more than 60 days, they will also pay coinsurance.
Glaucoma is an eye condition, and doctors do several tests to make a diagnosis.
Higher risk groups include older adults and those with high blood pressure, diabetes, or a family history of glaucoma. African American and Latinx people are at risk from a younger age.
Different parts of Medicare pay for preventive screening, drugs to treat the condition, and surgery.