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Does Medicare Cover Rhopressa?

Does Medicare Cover Glaucoma Surgery?

Glaucoma is a serious health condition that affects our eyes.

There are certain age and ethnic factors that put a person at more risk of having glaucoma in their eye/s. Original Medicare provides coverage for various glaucoma treatments. But is surgery for the condition included? 

This leads to a common question people have about glaucoma which is, “Does Medicare cover glaucoma surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of glaucoma surgery for those who don’t have insurance coverage.

Does Medicare Cover Glaucoma Surgery?

The short answer is yes; Medicare will cover the cost of glaucoma surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your glaucoma surgery. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for glaucoma surgery. Medicare will provide coverage for your glaucoma surgery if it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage. 

Coverage for some treatments for glaucoma is provided by Medicare Part A if it takes place in an inpatient setting. However, Medicare Part A does not provide coverage for glaucoma surgery even if it takes place in a hospital setting. 

Coverage for glaucoma surgery is usually provided by Medicare Part B. That is because many treatments for glaucoma are outpatient procedures, including glaucoma surgery. Medicare Part B provides coverage for a lot of treatments for glaucoma. 

Medicare Part B also provides coverage for glaucoma screening. Part B provides coverage for glaucoma screening every 12 months. However, Medicare Part B will only provide coverage for the screening every 12 months if you are considered at high risk of developing glaucoma.

You are considered at high risk of developing glaucoma if you are/have:

  • Diabetes
  • A family history of glaucoma
  • Black and over the age of 50 years
  • Hispanic and over the age of 65 years

Once approved, Medicare Part B covers 80 percent of the costs of most of your treatment and screenings for glaucoma. You will pay for the remaining 20 percent as coinsurance.

Part C and Part D Coverage for Glaucoma Surgery

Medicare Advantage plans (Medicare Part C) also provide coverage for the treatment and screening for glaucoma. They must cover everything Original Medicare covers, but will offer coverage on other treatments, services, etc. that Original Medicare does not cover. What a plan covers and what your out-of-pocket costs will be for that coverage will vary depending on the specifics of your plan.

Unlike Original Medicare, Medicare Part C plans also provide coverage for routine vision care, including the purchase of eyeglasses and other vision services not covered by Original Medicare.

Medicare Part D also provides coverage for prescription medications used for treating glaucoma. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies. 

How Much Does Glaucoma Surgery Cost?

Laser surgery for glaucoma ranges from less than $1,000 to $2,000 if you do not have insurance to cover the costs. Meanwhile, conventional surgery in a hospital can cost $11,000.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare Cover Panniculectomy?

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