Does Medicare Cover Glaucoma Screenings?
Even though Original Medicare does not cover routine eye exams, Medicare Part B medical insurance will cover one glaucoma screening every year if you are at high risk for the condition. Medicare Advantage plans will also cover annual glaucoma screenings but may offer additional vision benefits.
When Does Medicare Cover Glaucoma Screenings?
Medicare Part B medical insurance covers glaucoma tests once every 12 months if you meet Medicare’s definition of being at high risk for developing glaucoma.
- African-Americans age 50 or older
- Hispanics age 65 or older
- People who have been diagnosed with diabetes
- People who have a family history of glaucoma
Medicare will not cover a glaucoma test unless the screening is done by an eye doctor who is legally permitted by the state where it’s done to conduct a glaucoma test or supervise it.
How Much Will Medicare Pay for Your Glaucoma Screening?
Medicare will pay 80 percent of the cost once you have met your Medicare Part B deductible. You will have to pay 20 percent of the Medicare-approved amount for the screening.
If the screening takes place in a hospital outpatient facility, you will also have to pay a copayment.
Costs for glaucoma tests vary by doctor and depend on the type and number of tests a doctor may perform. You should talk with your doctor or other health care provider before the test to find out how much it will cost and whether Medicare will cover a portion of the screening.
- How much your doctor charges
- Medicare approves a certain price for the services it covers. If the price is higher than that, your share of the cost will be protected only if the doctor accepts assignment from Medicare for the glaucoma test.
- Whether your doctor accepts assignment
- Accepting assignment means that your doctor or other health care provider agrees to accept the Medicare-approved amount for the glaucoma screening as payment in full for the test. If the doctor does not accept assignment, your out-of-pocket costs may be higher and you may have to submit any claim to Medicare yourself.
- Other insurance
- If you have other health insurance, Medicare may be the secondary payer. That means your other insurance will pay first for the glaucoma screening and Medicare will pay second. This could affect your out-of-pocket expenses.
- Type of facility where the test is done
- Medicare Part B — which covers glaucoma screenings — pays for medical services generally performed outside a hospital setting. If the screening is done in a hospital or a hospital outpatient setting, Medicare Part B will not cover as much of the costs and you will have higher out-of-pocket expenses.
- Where you get the glaucoma screening
- If you have a Medicare Advantage plan, it will most likely have a network of doctors and other health care providers. If you go outside that network, you will most likely have to pay a larger share or all costs for the screening. Check with your plan to make sure you’re covered.
What Are Glaucoma Screenings?
Glaucoma is the leading cause of blindness in people over 60. It occurs when fluid builds up in the front part of the eye. The fluid increases pressure and damages the optic nerve.
It can be prevented, but requires routine glaucoma screenings to detect it early, according to the American Academy of Ophthalmology.
A comprehensive glaucoma screening typically requires five types of tests measuring different factors that may indicate whether you have glaucoma, according to the Glaucoma Research Foundation.
- Tonometry is the glaucoma test most people are familiar with. Drops numb the eye and the doctor uses a puff of air to measure the inner pressure of the eye.
- A pachymetry measures the thickness of your cornea — the clear part at the front of your eye — by placing a device called a pachymeter on the cornea. It only takes about a minute to measure both eyes. The thickness of the cornea can help measure the pressure in the eye.
- An ophthalmoscopy checks the shape and color of the optic nerve. Drops dilate the eye and the doctor uses a device that lights and magnifies the eye to see if the optic nerve is the proper shape and color. If not, the doctor may order two other tests — gonioscopy and perimetry.
- A gonioscopy measures the angle at which the iris meets the cornea to see if the iris is wide and open or narrow and closed. Drops numb the eye and the doctor uses a contact lens with a mirror to check for two types of glaucoma.
- Perimetry requires you look straight ahead as a dot of light flashes in different spots around your field of vision. It allows the doctor to map your vision. These are usually done twice a year to check for changes in your vision.
Regular eye exams feature just two of these tests: tonometry and ophthalmoscopy. But you may need to take a more comprehensive examination featuring more or all of these glaucoma tests.
Glaucoma is often difficult to diagnose and the tests can zero in on an accurate diagnosis. But you still may be referred to a glaucoma specialist if your examining doctor can’t gather enough information to make a diagnosis.
Original Medicare, Medicare Advantage and Vision Coverage
- Glaucoma tests once a year if you are at high risk for glaucoma
- Tests once a year for diabetic retinopathy if you have diabetes
- Certain tests and treatment for age-related macular degeneration
For the most part, Original Medicare will not cover routine eye exams for glasses or contact lenses.
Medicare Advantage plans are required to cover everything Original Medicare covers. But these plans may have additional benefits, including vision coverage.
When choosing a Medicare Advantage plan, you should make sure it includes vision coverage if that’s important to you.
9 Cited Research Articles
- Boyd, K. (2020, October 9). What Is Glaucoma? Retrieved from https://www.aao.org/eye-health/diseases/what-is-glaucoma
- Medical News Today. (2020, July 17). Does Medicare Cover Tests for Glaucoma? Retrieved from https://www.medicalnewstoday.com/articles/medicare-glaucoma-screening
- U.S. Centers for Medicare & Medicaid Services. (2020, January 14). Get a Glaucoma Test and Make Your Vision Top Priority. Retrieved from https://www.medicare.gov/blog/get-glaucoma-test-make-vision-priority
- Glaucoma Research Foundation. (2020, January 9). Five Common Glaucoma Tests. Retrieved from https://glaucoma.org/five-common-glaucoma-tests/
- U.S. Centers for Medicare & Medicaid Services. (2017, January 19). Glaucoma Awareness Month: Make a Resolution for Healthy Vision. Retrieved from https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2017-01-19-eNews#_Toc472501438
- U.S. Centers for Medicare & Medicaid Services. (2007, Glaucoma). Retrieved from https://www.lociceromedicalgroup.com/wp-content/uploads/glaucoma.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Glaucoma Tests. Retrieved from https://www.medicare.gov/coverage/glaucoma-tests
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Eye Exams (Routine). Retrieved from https://www.medicare.gov/coverage/eye-exams-routine
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Lower Costs With Assignment. Retrieved from https://www.medicare.gov/your-medicare-costs/part-a-costs/lower-costs-with-assignment