Does Medicare Pay for Glaucoma Care?

Whether you are enrolled in original Medicare (parts A and B) or a Medicare Advantage plan, your coverage includes glaucoma screening tests and treatments.

The doctor who performs the test or procedure must be enrolled in Medicare and legally licensed to perform glaucoma screenings in your state.

If you’re “at high risk” for developing glaucoma, Medicare Part B will pay for glaucoma tests once every 12 months. Although other conditions can elevate your risk of glaucoma, Medicare considers you at high risk if you:

• have diabetes
• have a family history of glaucoma
• are Black and over 50 years old
• are Hispanic and over 65 years old

Next, we’ll go over what each part of Medicare covers specifically for glaucoma care.

Part A coverage

Medicare Part A covers the costs of inpatient treatment in a hospital.

However, most glaucoma treatments — even those performed in a hospital setting — are considered outpatient surgery. This means it’s rare that Part A would cover these procedures.

Part B coverage

Medicare Part B pays for outpatient medical services, including glaucoma screenings and care you receive in a hospital or freestanding medical center.

If you have a laser procedure or eye surgery to treat glaucoma and you go home the same day, Medicare Part B will cover your treatment. Medicare may consider you an outpatient even if you stay overnight in the hospital for observation following your eye surgery.

Part C coverage

Medicare Part C (Medicare Advantage) plans offer the same level of coverage as original Medicare, so they’ll cover your glaucoma screenings and treatments. Your plan may offer extra vision care benefits, like routine eye exams or glasses.

Having a Medicare Advantage plan might also mean you need to go to a doctor or facility in your plan’s network. Be sure to confirm that all your providers are in network before receiving any treatments to avoid having to pay the full cost.

Part D coverage

Medicare Part D plans cover prescription medications you’ll need to treat glaucoma, including eye drops. Because Part D plans are all different, check your plan’s list of covered medications, called a formulary, to get an idea of what your medication copay costs will look like.

Medigap coverage

If you have a Medigap plan, also called Medicare supplement insurance, it may help you pay the costs of deductibles, copays, coinsurance, or excess charges from your glaucoma treatment.

Since each Medigap plan is different, you’ll need to check your coverage beforehand, so you’ll know if you have any remaining costs to pay.

Original Medicare doesn’t pay for routine vision care, including glasses or contact lenses.

Even if your healthcare provider believes you should have glaucoma screenings more often than once per year, Medicare generally won’t cover the extra tests. You’ll need to pay for those fully out of pocket.

As with coverage, the costs you can expect for glaucoma treatment will differ based on your coverage. Here’s a look at some of costs you might expect with each part of Medicare.

Part B costs

If you’re enrolled in original Medicare, you’ll pay 20 percent of the cost of a glaucoma screenings and treatments after you’ve met your Part B annual deductible. In 2020, the Part B deductible is $198.

With Part B, you’ll also pay a monthly premium of $144.60.

Note

Some facilities also charge fees on top of the procedure costs, so ask about this before you have any treatment.

Part C costs

If you’re enrolled in a Part C (Medicare Advantage) plan, your costs will be set by your specific plan. Talk with your healthcare provider and your insurance company ahead of time so you’re not met with any surprise costs following your treatment.

Part D costs

Part D prescription drug plans are private insurance plans, just like Medicare Advantage plans. To find out the costs of your eye drops or oral medications, check your Part D plan’s formulary or contact the insurance provider directly.

For your eyes to function normally, they have to maintain a healthy fluid pressure. As your body makes fresh fluid (called aqueous humor), older fluid flows out through a small opening near your cornea, which is the clear shield on the front of your eye.

When the fluid can’t drain properly, pressure builds. This damages the delicate fibers of your optic nerve, leaving blind spots in your field of vision.

A 2018 study indicates that an immune response to bacterial infection may also increase pressure in your eyes.

If glaucoma isn’t treated, it can eventually cause total blindness in that eye.

What are the different types of glaucoma?

There are two different kinds of glaucoma.

The most common type, primary open-angle glaucoma, is usually painless. Over time, fluid slowly builds up under your cornea. The fluid increase is so gradual that you might not notice any vision changes right away.

Closed-angle glaucoma is much rarer. It happens when your iris (the colored part of your eye) is very close to the opening where fluid should flow out. The iris blocks the outflow, and drainage stops.

Closed-angle glaucoma happens very suddenly, and it’s considered an emergency.

What are the symptoms of glaucoma?

People over 40 years old are at higher risk of developing glaucoma. Some other factors that can increase your risk include:

• thinned corneas or optic nerves
• diabetes, migraines, circulation problems, or high blood pressure
• family history of glaucoma
• long-term use of steroid medications

The following symptoms may mean you’re experiencing closed-angle glaucoma. If you notice any of these, contact your eye doctor immediately:

• blurred vision
• eye pain and headache
• nausea and vomiting
• colorful rainbow rings in your field of vision

How is glaucoma treated?

Glaucoma damage is permanent, so treatment is aimed at reducing pressure in your eyes to prevent further damage. Your treatments might include:

• medicated eye drops that reduce the amount of fluid in your eyes
• prescription medications
• laser therapies
• trabeculectomy or implant surgery
• minimally invasive glaucoma surgery

Laser surgeries and incision surgeries can be very effective at reducing the pressure in your eye. Exactly how successful the surgeries will be may depend on:

• how advanced your glaucoma is
• the type of surgery performed
• other factors specific to you

What can I expect with laser treatment?

Laser therapies can be slightly uncomfortable. People often feel a stinging sensation during the treatment, even though the area has been numbed.

Your treatment may take place in a hospital or in an outpatient setting. Most people are able to go home the same day. Usually, you can get back to your normal activities after a day or so.

What can I expect with other surgical treatments?

In eye-draining surgeries, doctors make a small incision in your eye tissue to release some of the fluid buildup. Sometimes, a small tube is used to better drain your eye.

These surgeries may take place in a hospital, but you can usually go home the same day as your procedure.

Trabeculectomy and glaucoma implant surgeries are effective for reducing eye pressure, but your recovery period will be longer than with a laser procedure.

Glaucoma is a condition that causes damage to your optic nerve. It’s caused when too much fluid builds up inside your eye.

Medicare pays for annual screenings from approved healthcare providers to help detect glaucoma early, but only if you’re in a high-risk group.

If you’ve been diagnosed with glaucoma, Medicare will pay for your treatment, including:

• prescription medications
• eye drops
• laser treatments
• eye surgeries

Since most of these treatments are considered outpatient services, Medicare Part B covers 80 percent of the costs of your glaucoma care, after you’ve paid your deductible. A Medicare Advantage (Part C) plan will cover at least as much as Part B.