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Does Medicare Cover Glaucoma Surgery? Everything You Need To Know

Does Medicare cover glaucoma surgery? Many people don’t know that Medicare may cover Glaucoma Screening costs. If you worry about the cost, it’s worth a call to find out if this service can be covered by Medicare. Here is Medicare’s phone number, if you need it 1-800-633-4227. Glaucoma screening is important for anyone over 40 years old who has risk factors associated with developing glaucoma, or those who have already been diagnosed with glaucoma. Original Medicare and Medicare Advantage will cover glaucoma. Medicare considers glaucoma to be a medical condition. In general, Medicare will cover for what a doctor deems medically necessary, and not experimental, and not cosmetic. When Medicare says it doesn’t cover vision, what it is referring to is eye exams, glasses, contacts for the routine maintenance of our eyes.

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What is Glaucoma?

Glaucoma, an insidious condition that causes blindness and does not have any symptoms until it has already progressed too far. We all need our sight in order to live life effectively; so make sure you’re taking care of yourself with regular visits for checkups at the optometrist’s office! Glaucoma typically develops slowly, so it may not be detectable until significant vision loss has occurred. For those of you who are unaware, Glaucoma is a disease where fluid pressure builds up in your eye and can lead to vision loss. It comes in two types: open-angle glaucoma (accounting for 80% of all cases) and closed-angle glaucoma.

What are the Symptoms?

The most common early warning sign of glaucoma is a gradual rise in eye pressure. But there are other signs to watch for as well. These include blurring or loss of vision, seeing halos around lights at night time (known as transient or acute glaucoma), and seeing double. Eye discomfort and redness around or near the eyes are also signs. Some signs might indicate glaucoma in other parts of the body, such as unexplained loss of peripheral vision or a painless gradual decrease in central visual acuity. The earlier you detect glaucoma, the better your chances of living a healthy life.

Does Medicare Part B Cover Glaucoma Screenings?

Let’s get into the specifics of what Medicare covers. I take this directly from the Medicare and You Handbook. “Medicare covers these tests once every 12 months for people at high risk for the eye disease glaucoma. Part B will cover glaucoma screenings. Medicare Part B is a supplemental insurance policy for people who are eligible to receive Social Security benefits and have paid Medicare taxes while working.

Now that we know Original Medicare, Medicare Supplements, and Medicare Advantage will cover glaucoma, let’s get into what Part of Medicare covers glaucoma and how much it costs. Medicare Part B primarily covers glaucoma. By far, Medicare Part B covers the majority of glaucoma treatments and surgeries. Almost everything that is related to glaucoma will be covered on an outpatient basis, even outpatient surgery. Your glaucoma medical exam is outpatient and has coverage through Medicare Part B. Therefore, it would be highly unlikely any Medicare Part A services will cover or be needed for your glaucoma treatment.

Here’s the Most Important thing You Need to Know about Medicare Advantage Glaucoma Screenings

Medicare Advantage will cover your glaucoma screening and your Medicare Advantage plan must offer at least the same level of coverage as Original Medicare. You’ll be responsible to pay the assigned copayments of the plan. Your copayments will apply after your deductible has been met if your plan has a deductible. If you do have a Medicare Advantage plan, it is likely you will need to see in-network physicians and facilities to have your services covered. Depending on whether you have an HMO or PPO Medicare Advantage plan.

How do You Get Medicare Coverage for a Glaucoma Screening 

A screening is a test in which people are checked for certain diseases or conditions to find out if they have them. Medicare will cover glaucoma screenings, but only after you’ve been diagnosed with the condition and your doctor has prescribed it as part of treatment.

  • If your doctor prescribes it as part of treatment, find out if he or she will bill the procedure to Medicare. Your doctor has to be enrolled in the program and meet certain qualifications before they can do this. They also have to send all billing information about that service that they provide to Medicare.
  • If the doctor’s not enrolled or meeting all qualifications, find a different glaucoma specialist in your area and do the screening for you. They’ll need to be enrolled before they submit any billing information about it to Medicare.

Who Qualifies for the Screenings, and how much does it Cost?

Not all are qualified for the screenings. Medicare will cover it if they are enrolled in the program and meet certain qualifications, which include:

  • having glaucoma
  • being at least 40 years old
  • living within a 25-mile radius of an eye care professional that is qualified to administer this kind of screening

The cost could be up to $623 per year for one eye or $1279 for both eyes. For people who enroll in Medicare Savings Programs, this cost may be lower. Meanwhile, for people who have an end-stage disease, the cost of glaucoma screenings will be covered.

Is Everyone at risk for Glaucoma?

Everyone is at risk for glaucoma, but not everyone will develop the condition. According to Prevent Blindness America (PBA), “approximately 90% of people with glaucoma have NO idea they are at risk.” It’s important to know your family history, as it may predispose you or a loved one to developing glaucoma. You should biannually visit an eye doctor to have a glaucoma screening. Glaucoma is a condition that can be hard to diagnose, but there are many factors for this. Some of the most common include being over 40 years old and having high blood pressure or diabetes mellitus. 

Some people may have inherited conditions that increase their risk as well such as pseudoexfoliation glaucoma, pigment dispersion syndrome (PDS), central serous chorioretinopathy (CSCR), or these related diseases: primary open-angle glaucoma with an increased eye fluid production; narrow-angle type II secondary open-angle where intraocular pressures fluctuate wildly due to pupil dilation from a light change. For example, people with a family history of African Americans over 40 years old may be at higher risk for this condition. Nearsightedness and other eye conditions also play a role in developing it as well.

How does Medicare Part D Cover Glaucoma?

Part D is the portion of Medicare that covers outpatient prescription drugs. That is just a fancy term for getting your prescriptions at a pharmacy or through a mail-order pharmacy.  Here is a chart with some common prescriptions for glaucoma. The most common I see my clients being prescribed is Latanoprost and Timolol. I got these drugs from a webpage on glaucoma.org.

What does Medicare Cover for a Glaucoma Test?

Glaucoma tests can be expensive and involve the use of eye drops, laser treatments, or surgery to prevent blindness. Medicare covers the bulk of your expenses for glaucoma tests, but you have to pay 20% out-of-pocket. If a doctor prescribes an annual eye exam where they check your eyesight with measurements of pressure inside the eye (IOP). To learn more about how a Medicare Supplement can cover the 20% Medicare doesn’t pay for view our video and blog post here.

Does Medigap Cover Glaucoma Tests?

Medicare Supplement Plans are here to help you cover costs for those pesky glaucoma tests. By filling in the gaps in Medicare coverage, Medigap plans can pay the 20% Original Medicare doesn’t pay for glaucoma tests and other medical care. For instance, if you have a Medigap plan and Medicare covers glaucoma tests, then you will pay the first $203 in 2021 for your Medicare Part B deductible. After your Medicare Part B deductible has been satisfied, then Medicare will pay 80% of approved amounts and you will be responsible for the other 20%. The Medigap would cover the other 20% cost for you.

How Is Glaucoma Treated?

  • Glaucoma is treated with eye drops, surgery, or laser.
  • Eye drops are used to decrease the pressure inside the eyeball and also reduce pain from glaucoma by opening the blood vessels in front of your iris (the colored part of your eye).
  • Surgery can involve removing all or a portion of the eye that is damaged by glaucoma.
  • A laser can be used to treat the abnormal areas of your eye that cause glaucoma.

After surgery, your doctor may recommend a check-up every six months for several years. Doctors do this so they can evaluate if there’s any remaining damage from glaucoma to prevent blindness or the need for further surgery.

Does Medicare Cover Glaucoma Surgery? Everything You Need To Know — Conclusion

Original Medicare and Medicare Advantage do cover glaucoma because it is a medical condition. Original Medicare doesn’t cover the routine maintenance of eyes, ears, or teethMedicare Part B will most likely cover glaucoma. You are responsible for the Part B deductible and the Part B 20% coinsurance. If you have the right Medicare Supplement it will pay the Part B 20% coinsurance. If you have a Medicare Advantage you’ll be responsible for any deductibles if your plan has a deductible, and any copays your plan has. Original Medicare and Medicare Advantage will cover a glaucoma screening every 12 months for those at high risk. Prescriptions for glaucoma can be covered under your Part D prescription drug plan. If you have glaucoma, make sure to research Part D plans. This is to ensure your drugs are covered in the plan’s formulary.

Thanks for reading this blog post! I really appreciate your feedback, so feel free to leave any questions or comments.

About The Author — Christopher Duncan

I’m Chris Duncan, your specialist Medicare Advisor, and I own an Independent Medicare Agency, Trusted Benefits Direct. I do not work for insurance companies; instead, I work for you, and all of my resources are free of cost. Since I’m independent, I get to endorse various companies, ensuring that you make the best choice regarding your needs. Among other things, I help with Medicare Supplements, Medicare Advantage, Medicare Part D, Final Expense life insurance, and retirement security. It’s easy to communicate with me. You can reach me toll-free at 800-910-3382, or you can get a free Medicare Supplement Quote at MedicareRateQuote.com. You can fill out my contact form on my main website www.trustedbenefitsdirect.com.

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