Medicare Coverage for Glaucoma

If you are at high risk for glaucoma, Medicare Part B covers a glaucoma test once every 12 months. You are considered high risk if you have diabetes, a family history of glaucoma, are African American and 50 or older, or are Hispanic and 65 or older. The screening must be done or supervised by an eye doctor who is legally allowed to do this test in your state.

For the screening itself, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. If you have a Medicare Supplement (Medigap) plan, it will step in to cover that 20% coinsurance, leaving you with little to no out-of-pocket cost for the test once your deductible is met.

When it comes to treating glaucoma, Medicare Part B covers medically necessary treatments, including prescription eye drops and surgical procedures. However, the coverage for prescription medications falls under Medicare Part D. If you need daily eye drops to manage your condition, you will need a standalone Part D prescription drug plan to help cover those costs.

We know that navigating Medicare can feel like walking through a maze blindfolded. The paper promises of some plans might look good until you actually need them. That is why we believe in straight answers, no surprises. We are on your side of the table, ready to walk you through every option so you can protect what you've earned.

Remember, the real choice you are making is between Traditional Medicare (Parts A and B) and Medicare Advantage. If you choose the Traditional path, a Medigap policy is designed to fill the gaps by law, covering the coinsurance and copayments that Medicare leaves behind. This means you can see any doctor who accepts Medicare, anywhere in the country, without needing a referral for your glaucoma specialist.

If you opt for a Medicare Advantage plan, your coverage for glaucoma screenings and treatments will depend on the specific plan's network and rules. You may need referrals and could face different copayments or coinsurance structures.