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.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance 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. 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.
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 B 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 medication copayment.
Glaucoma surgery costs
When a person requires surgery, it may be difficult to determine the exact costs beforehand because the individual may need extra services.
Medicare Part B covers outpatient glaucoma surgery–if the person goes home the same day. Medicare Part B may also consider you an outpatient if a patient stays overnight for observation after surgery.
Medicare Part A covers medically necessary surgeries, such as those required to repair eye function due to chronic eye conditions like glaucoma following in-hospital observation.
Medicare Part C (Medicare Advantage) plans also cover glaucoma treatments, and Medicare Part D covers medications after surgery. If a person stays in the hospital for more than 60 days, they will also pay coinsurance.
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.
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
Anyone can get glaucoma. However, anyone with a blood relative who has glaucoma will have a higher risk. 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.
Normal-tension glaucoma
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.
Angle-closure glaucoma
This type of glaucoma is rare and develops quickly when fluid cannot drain from the eye. Symptoms include:
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 for the individual to receive testing coverage. Different parts of Medicare pay for preventive screening, drugs to treat the condition and surgery.