Original Medicare will only provide coverage for eye health services if it is considered medically necessary. On the other hand, Medicare Advantage plans provide coverage for routine vision services and care. But what about treatment for glaucoma? Will Original Medicare provide coverage for it?
The question “does Medicare cover glaucoma treatment?” is a common one. And in this article, you will get the answer that question in clear, plain English. You will also find the average costs of treatment for glaucoma.
Does Medicare Cover Glaucoma Treatment?
The short answer is yes. Medicare will cover the cost of treatment for glaucoma. 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 treatment for glaucoma. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for treatment for glaucoma. More specifically, Medicare provides coverage for your treatment for glaucoma IF it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Most of the time, coverage for treatment for glaucoma is provided by Medicare Part B. That is because many treatments for glaucoma are outpatient procedures.
Medicare Part B also provides coverage for glaucoma screening. Medicare Part B provides coverage for glaucoma screening once 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:
- A family history of glaucoma
- Black and over the age of 50 years
- Hispanic and over the age of 65 years
Aside from screening, Medicare Part B also provides coverage for surgery for glaucoma. Once approved, Medicare Part B covers 80 percent of the costs of most of your treatments and screenings for glaucoma. You will pay for the remaining 20 percent as coinsurance.
Part C and Part D Coverage for Glaucoma Treatment
Medicare Advantage plans (Medicare Part C) also provide coverage for the treatment and screening for glaucoma. These plans have to cover the same treatments and services that Original Medicare covers. They will also provide coverage for some things that Original Medicare does not. What extra treatments and services are covered and how much the plans cost depends on the plan you have.
Medicare Part D also provides coverage for prescription medications used for treating glaucoma. Medicare 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 Treatment Cost?
Eye drops to treat glaucoma may cost between $150 and $2,000 per year. Eye surgery can cost anywhere from $1,000 to $11,000 depending on the type of surgery.
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 bone grafts?