Does Medicare Pay for Glaucoma Treatment?

Glaucoma is a group of eye conditions that progressively damage the optic nerve, often due to elevated pressure within the eye. This damage can lead to irreversible vision loss and, if left untreated, blindness. Early detection and consistent management are important for preserving sight. Medicare offers coverage for various aspects of glaucoma care. Coverage varies by service and plan.

Medicare Coverage for Glaucoma Diagnosis

Medicare Part B provides coverage for the diagnostic phase of glaucoma for high-risk individuals. High-risk categories include:
Individuals with diabetes
A family history of glaucoma
African Americans aged 50 and older
Hispanic individuals aged 65 and older

An annual glaucoma screening is covered for individuals in these groups.

Medically necessary diagnostic services covered under Medicare Part B include:
Dilated eye exams with intraocular pressure measurements
Direct ophthalmoscopic examinations
Slit-lamp biomicroscopic examinations
Visual field tests
Optic nerve imaging (e.g., Optical Coherence Tomography or OCT)

Medicare Coverage for Glaucoma Treatment

Once glaucoma is diagnosed, Medicare extends coverage to various treatment modalities. Coverage requires the treatment to be medically necessary and performed by a Medicare-approved provider.

Prescription medications, like eyedrops and oral medications for glaucoma, are covered under Medicare Part D. These plans are offered by private insurance companies approved by Medicare and involve premiums, deductibles, and cost-sharing arrangements like copayments or coinsurance. Each Part D plan maintains a list of covered drugs, known as a formulary, and the cost-sharing can vary based on the drug’s tier within that formulary.

Laser treatments for glaucoma, such as Selective Laser Trabeculoplasty (SLT), Argon Laser Trabeculoplasty (ALT), and Laser Peripheral Iridotomy (LPI), are covered under Medicare Part B as outpatient procedures. More invasive surgical options, including trabeculectomy, glaucoma drainage device implantation, and minimally invasive glaucoma surgeries (MIGS), are also covered by Medicare Part B in an outpatient setting. If an inpatient hospital stay becomes medically necessary for a surgical procedure, Medicare Part A would provide coverage.

Understanding Costs and Additional Coverage Options

Original Medicare involves out-of-pocket costs for glaucoma care. For 2025, the Part A deductible is $1,676 per benefit period. For services covered under Part B, beneficiaries must meet an annual deductible, which is $257 in 2025, and then pay a 20% coinsurance of the Medicare-approved amount for most services. These costs can accumulate, depending on the frequency and complexity of the required glaucoma services.

Medicare Advantage Plans

Medicare Advantage Plans (Part C) are offered by private insurance companies and provide an alternative way to receive Medicare benefits. They must cover at least the same services as Original Medicare, including glaucoma diagnosis and treatment. However, Medicare Advantage plans may have different cost-sharing structures, such as copayments for doctor visits instead of a 20% coinsurance, and may include prescription drug coverage (Part D) as part of the plan. They often have their own provider networks and out-of-pocket maximums, which can influence total expenses.

Medicare Supplement Insurance

Medicare Supplement Insurance (Medigap plans) are private policies designed to help cover some Original Medicare out-of-pocket costs. They work with Original Medicare, covering expenses like deductibles, copayments, and coinsurance. Medigap policies do not work with Medicare Advantage plans. The specific benefits and premiums of Medigap plans vary, but they can significantly reduce a beneficiary’s financial responsibility for services covered by Original Medicare.

Medicare Part D Low-Income Subsidy

For individuals with limited income and resources, the Medicare Part D Low-Income Subsidy (“Extra Help”) can assist with prescription drug costs. This program helps lower or eliminate Part D premiums, deductibles, and copayments. Eligibility depends on income and resource guidelines; some individuals may qualify automatically if they receive Medicaid or Supplemental Security Income.