Does Medicare Cover Glaucoma?
This article was updated on: 09/10/2018
Medicare covers treatment of glaucoma as well as a glaucoma test to screen for the condition.
According to the National Institute of Health’s National Eye Institute (NEI), glaucoma is a type of eye disease that may damage the optic nerve and cause vision loss or even blindness. In fact, according to the NEI, glaucoma is one of the leading causes of blindness in the U.S. The best way to control glaucoma is through early diagnosis and treatment. Because the chance of developing this eye disease increases as people age, it’s important to learn about Medicare coverage for glaucoma.
The NEI advises people in high-risk groups to have their vision screened every year or two. Individuals over 60, those with a family history of glaucoma, and African Americans 50 years and older are considered high risk for glaucoma. Remember, even though risk may increase with age for certain groups, it’s important to note that this disease could strike at any age.
Because those over 60 are considered high risk for glaucoma, it’s important for Medicare beneficiaries to understand Medicare coverage for glaucoma treatment and preventive services.
Medicare coverage for glaucoma tests
Because early diagnosis is key to successful treatment, you may be wondering about Medicare coverage for glaucoma screening tests. Medicare Part B covers a screening every 12 months for those who are considered high risk. To be covered, you must get this test from an eye doctor who’s legally authorized to perform the screening in your state.
Medicare only covers the test for beneficiaries who have a high risk of getting glaucoma. You’re considered high risk if any of the following factors are true:
- You have diabetes.
- You have a family history of glaucoma.
- You are an African American and 50 years old or older.
- You are a Hispanic American who is 65 years old or older.
Under Original Medicare, your Part B costs for the glaucoma screening are as follows:
You pay 20% of the Medicare-approved cost for the test, and you also have to pay the Part B deductible if you haven’t met it yet for that year.
If you have the test in a hospital outpatient setting (for example, an observation clinic), then you also have to pay a copayment.
Medicare coverage for glaucoma treatment
According to the Glaucoma Foundation, treatment options for glaucoma may include prescription medications, surgery, or a combination of both types of treatment. With early detection and proper treatment, those with glaucoma may be able to minimize the effects of vision loss.
Original Medicare (Part A and Part B) covers treatment for eye-related conditions. If you get glaucoma, your doctor may suggest medication, surgery, laser surgery, or more than one of these methods combined.
Part A will cover services or treatment if you get care in an inpatient hospital or skilled nursing facility setting. Part B covers any care you get in an outpatient setting, including office visits, doctor services, and lab tests.
Please note that the costs you pay under Original Medicare, Part A and Part B, will depend on the type of treatment you need and whether the provider accepts Medicare assignment. If you use a provider that accepts assignment, this means that you won’t be charged more than the Medicare-approved amount for a medical service (although you’ll still be responsible for your share of costs, including deductibles, copayments, and coinsurance). If you’re unsure about your costs as a beneficiary, it’s a good idea to clarify with your medical providers or call Medicare to get a better idea of your expected costs. You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. For TTY services, call 1-877-486-2048.
While Original Medicare offers coverage for glaucoma treatments and a preventive screening, Medicare Part C is another option if you’re interested in vision benefits beyond what the government-run program covers. While Original Medicare doesn’t cover most routine vision services (such as eye exams or the cost of glasses or contacts), you may be able to get coverage for these benefits through Medicare Part C, which is available through Medicare Advantage plans that are offered through Medicare-approved private insurance companies. Medicare Advantage plans are an alternative way to get your Medicare Part A and Part B coverage and often include additional benefits, such as prescription drugs or routine vision or hearing benefits.
Would you like to learn about these Medicare plan options? I’d be happy to work with you to help you understand your benefits and explain Medicare plan options that could meet your health needs and budget.
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For more information, see:
The Glaucoma Foundation, “Treating Glaucoma,” last updated 2016, https://www.glaucomafoundation.org/treating_glaucoma.htm
The National Institutes of Health: The National Eye Institute, “Glaucoma,” https://nei.nih.gov/glaucoma
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