For people at high risk of glaucoma, Medicare Part B pays for annual preventive screening. Glaucoma testing can include a dilated eye exam, direct ophthalmoscopic examination, and more.
Healthcare professionals may treat some types of glaucoma with medication, whereas other types require surgery.
This article discusses Medicare coverage, eligibility, and costs for eye exams that can diagnose the condition. It also explains the different types of glaucoma and how the condition can develop.
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.
Medicare covers annual glaucoma screenings for individuals at higher risk for the condition. According to the Centers for Medicare & Medicaid Services (CMS), these groups include:
- African Americans ages 50 and older
- Hispanic people ages 65 and older
- people with diabetes mellitus
- people with a family history of glaucoma
If a person falls into one or more of these categories, Medicare Part B pays for preventive services.
This includes 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, per CMS.
When a doctor calls for medications to treat the condition, Medicare Part D will pay for prescriptions.
People sometimes require surgery to treat glaucoma. In this case, Medicare Part A will pay 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.
Specifically, Medicare Part B will cover the following glaucoma exam types:
- dilated eye exam with an intraocular pressure measurement
- direct ophthalmoscopic examination
- slit-lamp biomicroscopic examination
If the person needs medication, Medicare Part D or Medicare Advantage (Part C) 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 a person requires surgery, it may be difficult to find out the exact costs beforehand because the individual 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 plans, perhaps through work or a spouse, may cover costs
A person may also pay a copayment for outpatient surgery.
If the individual 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 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, according to the
Anyone can get glaucoma. However, people may inherit the disease, per the Glaucoma Research Foundation. This means a higher risk exists for anyone with a blood relative who has glaucoma. Family members of a person with glaucoma may need to undergo screening for the disease.
There are three main types of glaucoma:
Primary open-angle glaucoma
This type of glaucoma may cause gradual vision loss. A person will often see no typical signs or symptoms of the condition.
Healthcare professionals can make an early diagnosis only if a regular eye examination reveals it. The condition may improve with medication.
With this condition, the nerve becomes damaged despite typical 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
- eye pain
- sudden loss of eyesight
The condition is a recognized medical emergency and requires surgery.
Glaucoma is an eye condition, and doctors do several tests to make a diagnosis. If a person is in a high-risk category, Medicare will cover annual testing.
A doctor must document that a person belongs to a high-risk group in order for the individual to receive testing coverage. Different parts of Medicare pay for preventive screening, drugs to treat the condition, and surgery.