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 the 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 to see if you have any remaining costs to pay.

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

Note, too, that if you don’t have a diagnosis of glaucoma but your doctor believes you might be at risk, Medicare won’t pay for additional screenings beyond once yearly.

This differs from when you have a diagnosis of glaucoma. In this case, if your doctor wants to have more screenings to see if your condition is worsening, Medicare will pay for them.

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

Part B costs

If you’re enrolled in Original Medicare, you’ll pay 20% of the cost of glaucoma screenings and treatments after you’ve met your Part B annual deductible. In 2024, the Part B deductible is $240.

With Part B, you’ll also pay a monthly premium of $174.70.

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 professional and insurance company ahead of time so you’re not surprised by any unexpected costs after your treatment.

Part D costs

Part D prescription drug plans are private insurance, 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.

Your eyes need to maintain a healthy fluid pressure to function normally. Fresh fluid is made, while older fluid flows through a small opening near the cornea.

Glaucoma develops when this drainage is blocked. It causes the loss of peripheral vision and, eventually, the central vision. It’s one of the most common causes of blindness.

Learn more: Glaucoma surgery types and other treatment options.

What eye disease is covered by Medicare?

Medicare Part B also covers eye exams and treatment for diabetic retinopathy. This can cause neovascular glaucoma, which is different from the more common primary open-angle glaucoma. Part B also pays for cataract screening and treatment.

Is glaucoma treatment covered by private medical insurance?

Glaucoma is an eye disease, so treatment for this condition is typically covered by regular health insurance plans rather than vision health insurance plans. The Affordable Care Act requires all eligible insurance plans to provide coverage for eye diseases such as glaucoma.

Is glaucoma screening a covered screening for Medicare patients when performed every 6 months?

Medicare covers glaucoma screenings only once a year.

What is the typical cost of glaucoma?

A 2021 meta-analysis examined 177,352 people living with either glaucoma or ocular hypertension enrolled in a health insurance plan for at least a year before and after diagnosis.

Researchers found that those with glaucoma had a median out-patient cost of $516, which was higher than the cost for those with ocular hypertension. Other studies suggest the cost can range between $623 to $3,000 per year.

Glaucoma is a condition that causes damage to the optic nerve. It occurs when too much fluid builds up inside the 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. Medicare Part D will also pay for prescription drugs, but this coverage depends on your specific plan.

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% 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.