Understanding What Medicare Covers for Glaucoma Screening

In order for Medicare to cover your glaucoma screening, it must be done (or supervised) by a doctor who is legally qualified to conduct glaucoma tests in your state. The provider must also accept Medicare.

Glaucoma coverage varies based on the Medicare part or plan that you have.

Talk to your doctor or a Medicare specialist to find out the expected costs of a specific test or service. The amount you pay may depend on:

• any other insurance you might have
• how much your doctor charges
• whether your doctor offers the service
• where (including the type of facility) you get the test or service

Let’s look at the various parts of Medicare to see which cover glaucoma screening.

Original Medicare (Medicare parts A and B)

Original medicare includes Medicare Part A and Medicare Part B.

Part A typically covers expenses related to inpatient hospital visits, like surgery. Part B covers outpatient care, such as doctor’s visits, screenings, and routine care.

Original Medicare covers 80 percent of the Medicare-approved cost for glaucoma screenings.

This means that after you meet your Part B deductible, you’ll be responsible for paying 20 percent of the cost in the form of coinsurance.

Medicare Part B coverage typically includes a glaucoma screening once every 12 months if you’re considered high risk. Outpatient laser treatments may also be covered by Part B.

You’re considered high risk if one or more of the following applies to you:

• You’ve been diagnosed with diabetes.
• You have a family history of glaucoma.
• You’re Black and age 50 or older.
• You’re Hispanic and age 65 or older.

Medicare Advantage (Part C)

Medicare Advantage plans (also known as Medicare Part C) are private insurance plans that cover all the same the services included in original Medicare. They also include extra benefits and drug coverage, if you choose.

Because Medicare Advantage plans must provide the same level of coverage as original Medicare, these plans also cover glaucoma screenings.

You can use the Medicare plan finder tool to see which Medicare Advantage plans are available in your area, what they cost, and what they cover.

Medicare Part D (prescription drugs)

Medicare Part D is insurance for prescription medications.

Part D typically covers eye drops to treat glaucoma, but the exact cost and offerings of covered medications depends on which prescription drugs your plan covers. You can find these medications on your plan’s formulary, or list of covered prescription drugs.

Part D doesn’t pay for glaucoma screening tests.

Medicare supplement plans (Medigap)

Medigap plans cover gaps in your Medicare coverage, such as deductibles, copayments, and coinsurance. Depending on the state you live in, you may choose from among up to 10 standard Medigap plans.

If you have a Medigap plan, it may help pay for out-of-pocket costs for glaucoma screening that other parts of Medicare don’t cover.

It’s important to note that you may not purchase both Medicare Advantage and Medigap. If you want this coverage, you’ll need to choose one or the other.

You can use the Medicare plan finder tool to see what Medigap plans cost in your area.

It can be difficult to diagnose glaucoma. That’s why your eye doctor, an optometrist or ophthalmologist, will generally perform five tests during your glaucoma screening exam.

These tests include:

• Tonometry. This test measures the pressure within your eye. During tonometry, numbing drops may be placed in your eye. A very small amount of pressure is placed on your eye, either with a tiny device or a puff of warm air.
• Ophthalmoscopy. During this test, your doctor will look at your optic nerve to check for damage that may mean you have glaucoma. Your doctor may place drops in your eyes to dilate your pupils. This helps them see your optic nerve.
• Perimetry. Using a bright light, the doctor will measure your field of vision. There may be a point when you don’t see the light as it passes by the blind spot that everyone has.
• Gonioscopy. During this exam, numbing drops are placed in your eyes and a contact lens is gently placed on your eye. This lets the doctor measure where your iris (the colored part of your eye) meets the cornea (the clear covering at the front of your eye).
• Pachymetry. This painless test measures the thickness of your cornea. The doctor gently places a small probe called a pachymeter on the front of your eye and records a measurement.

Glaucoma is a condition in which fluid builds up inside your eye. This increases the pressure in your eye. Eventually, this pressure damages your optic nerve and can lead to blindness. However, there are effective treatments that can help prevent blindness if you have glaucoma.

There are two main types of glaucoma: primary open-angle glaucoma and angle-closure glaucoma (narrow-angle glaucoma).

Aside from chronic eye conditions, like glaucoma or cataracts, original Medicare (parts A and B) and Medigap plans don’t cover routine services for eye care, including:

• eye exams
• prescription glasses
• contact lenses

Medicare Advantage plans, on the other hand, typically do provide coverage for routine vision exams, glasses, and contacts.

If you have a chronic eye condition, Medicare usually covers:

• surgery and other procedures that help repair eye function
• a standard pair of untinted prescription glasses or contacts if you receive an intraocular lens after cataract surgery. If necessary, the plan might also pay for custom glasses or contacts.
• an eye exam to determine whether your vision problems indicate a more serious condition

If you have diabetes, Medicare will also cover an annual eye exam to check for eye problems related to your condition. Medicare Advantage plans are also allowed to cover additional services like vision, dental, and hearing.

• Medicare usually covers services for glaucoma, including screenings through Part B plans.
• Medicare Advantage plans generally cover glaucoma screenings, but you may have copays or coinsurance.