Does Medicare Cover Glaucoma Testing?
- Get the facts about Medicare coverage for glaucoma testing. Find out when Medicare is likely to cover tests and how much you can expect to pay out of pocket.
Glaucoma is one of the most common causes of blindness among adults over the age of 60, according to the Mayo Clinic. The disease occurs when pressure builds up in the eye and gradually causes damage to the optic nerve. While no cure for glaucoma exists, treatment can reduce your risk of permanent vision loss due to the disease. Early detection can greatly improve the success of treatment plans, making regular glaucoma testing important for those at risk for the disease. If you meet certain requirements, Medicare is likely to cover the cost of glaucoma tests.
Does Medicare Cover Glaucoma Testing?
Medicare covers glaucoma tests for people considered at high risk for developing the disease. For your tests to be covered, one of the following statements about you must be true:
- You're diabetic.
- Someone else in your family was previously diagnosed with glaucoma.
- You're African American and at least 50 years old.
- You're Hispanic and at least 65 years old.
Having thinned corneas or optic nerves, frequent migraines, circulatory problems and high blood pressure and using corticosteroid drugs for long periods of time also increase your risk of developing glaucoma. However, these risk factors on their own aren't sufficient to meet the glaucoma testing guidelines established by Medicare.
Types of Glaucoma and Their Symptoms
Doctors diagnose two kinds of glaucoma:
- Open-angle glaucoma is the most common form that happens when fluid gradually builds up behind the eye. Typically, this type of glaucoma causes no noticeable symptoms.
- Closed-angle glaucoma occurs when the colored part of your eye called the iris blocks the outflow of fluid. Typically, this type happens suddenly. Because it can quickly progress to complete vision loss, the condition requires emergency medical attention. Symptoms of closed-angle glaucoma include:
- Blurry vision
- Eye pain accompanied by a headache
- Nausea and vomiting
- Seeing rings that resemble rainbows in your field of vision
What Tests Are Done to Diagnose Glaucoma?
Your optometrist or ophthalmologist may recommend one or more of the following tests for glaucoma:
- Tonometry, which measures the pressure levels in your eye
- Ophthalmoscopy, which allows your doctor to examine your optic nerve for signs of damage
- Perimetry, which assesses how large your field of vision is to look for signs of glaucoma-related vision loss
- Gonioscopy, which checks the angle between your iris and cornea to determine if fluid can drain
- Pachymetry, which measures the thickness of the cornea
Does Medicare Part A Pay for Glaucoma Testing?
Medicare Part A pays for hospitalization and services that occur during stays in a hospital or long-term care facility. Most of the time, glaucoma testing is done in a doctor's office or outpatient clinic, so Medicare Part A is unlikely to pay for the service. Surgical interventions for glaucoma normally don't require hospitalization.
Does Medicare Part B Pay for Glaucoma Testing?
Typically, Medicare Part B is the part of Original Medicare that covers glaucoma testing. Your plan will usually pay 80% of the cost while you pay for the remaining 20%. For Medicare coverage to apply, you'll need to:
- Satisfy your deductible
- Be current on your monthly premium payments
- Meet the eligibility requirements for testing outlined above
- Choose a doctor that accepts Medicare
- Pay your share of the cost
You may also need to pay additional fees for the office visit, as Medicare Part B doesn't cover other routine eye exam costs.
Does Medicare Part C Pay for Glaucoma Testing?
Medicare Part C or Medicare Advantage Plans must provide at least as much coverage as Medicare Parts A and B. As a result, your plan will usually cover the cost of glaucoma testing under the same guidelines as Medicare Part B. For coverage to qualify, you:
- Must pay any deductible your plan requires
- Must have paid all your monthly premiums
- Meet eligibility requirements for testing. These cannot be stricter than the ones established by Medicare but may be more lenient, allowing more people to qualify for tests.
- Choose a doctor who accepts your insurance. You may need to select a doctor in your plan's network, depending on your insurance type and terms.
- Usually must pay a copay or coinsurance
If your Medicare Advantage Plan includes vision coverage, you may also get help paying for the fees associated with routine eye exams performed along with glaucoma testing.
Does Medicare Part D Pay for Glaucoma Testing?
Medicare Part D pays for prescription drugs. Your plan likely won't cover glaucoma testing; however, it may pay for eye drops or oral medications that your doctor prescribes.
Do Medicare Supplement Plans Pay for Glaucoma Testing?
Medicare Supplement or Medigap Plans help to cover some of the costs of expenses that Medicare Parts A and B don't pay in full. Your plan may pay for all or some of the 20% of the fee for testing that you're responsible for under Medicare Part B.
What Does Medicare Cover for Glaucoma?
In addition to testing, Medicare Part B may pay for:
- Laser therapy, known as selective laser trabeculoplasty to remove blockages. The treatment is usually performed in a doctor's office. During the procedure, your eye is numbed, but you may experience a stinging sensation. Most people can resume their normal daily activities one or two days after the therapy.
- Micro-Invasive Glaucoma Surgery (MIGS) surgery to reduce eye pressure. The surgery is typically done at a hospital on an outpatient basis. A variety of techniques are used to perform MIGS. How long your recovery time is depends on the type that your doctor selects for your treatment.
- Trabeculoplasty, a surgery to create an opening into your eye to encourage fluid drainage. Like MIGS, this procedure is generally done in a hospital setting on an outpatient basis. You'll likely need longer to recover from trabeculoplasty than laser therapy.
If your doctor deems any of these procedures as medically necessary, Medicare is likely to cover 80% of the cost, leaving you responsible for the remaining 20%.
Medicare Part D may cover medications for glaucoma, including:
- Prescription eye drops like prostaglandins, beta-blockers or alpha-adrenergic agonists
- Oral medications like carbonic anhydrase inhibitors
Eye drops are usually the first treatment that doctors prescribe for glaucoma. Although their exact mechanisms of action vary, these medications generally work by reducing the amount of fluid in your eyes. When eye drops alone fail to reduce eye pressure levels, doctors may add oral medications.