Does Medicare Cover Glaucoma Surgery? What You Need to Know

You’re nearing 65 or already over, and now “Medicare” is the hot topic. It feels like there is a lot to understand, and one thing you might be wondering about is your vision care. You want to make sure you keep seeing those grandkids for years to come. Glaucoma is something you might be worried about, so the question is, “Does Medicare cover glaucoma surgery” if the time comes?

Glaucoma can sneak up on you. This group of eye diseases damages the optic nerve, usually due to high pressure inside your eye. A scary fact is that it’s a leading cause of blindness, especially for people over 60. You’ll learn about this serious condition in this article, so let’s talk about how Original Medicare can help and other ways you can get coverage for eye exams.

Does Medicare Cover Glaucoma Surgery?

First, let’s address the million-dollar question—does Medicare cover glaucoma surgery? This is where it gets tricky, and the answer is…sometimes. Keep reading to learn more about Medicare coverage for glaucoma treatment and if you qualify.

Medicare Coverage for Glaucoma Treatment

Before we jump to surgery, Medicare Part B often helps with the costs of yearly glaucoma screenings, but this is generally limited to high-risk individuals. What are the risk factors, you ask? Glad you asked. Here they are:

You’ve got diabetes.
You have a family history of Glaucoma.
You’re African American and 50 years old or older.
You’re Hispanic American and 65 years old or older.

If you fall into these categories, your eye doctor can conduct a glaucoma test. Medicare Part B sometimes covers glaucoma treatments, like specific laser treatments and prescription eye drops. Medicare Part D usually picks up the tab for your glaucoma medications, so enroll in Medicare Part D during your Initial Enrollment Period.

However, regarding actual glaucoma surgery, Medicare Part B typically helps with the costs – but there’s a catch. Medicare likes to stick to the “medically necessary” script, and even then, you’ll probably still face out-of-pocket expenses. This can include:

Your yearly Part B deductible.
Coinsurance (generally around 20% of the Medicare-approved cost).
Any “excess charges” occur when doctors or other providers don’t entirely follow Medicare’s rules and charge above the Medicare-approved amount.

I bet you are wondering about your total costs. Well, this varies. Across the U.S., laser surgery costs are about $1,000 to $2,000 (and that’s before insurance). However, I highly recommend scheduling a visit with your doctor and hospital for an accurate estimate. This will give you a clearer idea of your financial responsibility regarding your medical insurance.

What If You Have Medicare Advantage?

Good news. If you signed up for a Medicare Advantage plan (also known as Part C), these plans are legally required to offer the same coverage as Original Medicare (including Part A and Part B), but there’s a big BUT coming. These plans can come with different out-of-pocket expenses compared to Original Medicare. Consider different copays, coinsurance amounts, and rules for using in-network providers.

However, you may have to dig deeper and read the plan’s fine print to see exactly how your Medicare Advantage plan handles glaucoma. Some MA plans even provide extra coverage, like routine vision and eyeglasses, which can come in handy if you face glaucoma. I recently wrote an interesting post about whether Medicare covers assisted living, so give that a read next.

Can You Get Help with Out-of-Pocket Expenses?

It would be nice to have additional help to cover gaps in your glaucoma surgery costs. Medigap is extra coverage to help with those expenses (think deductibles, coinsurance, copays). You pay a monthly premium for a Medigap policy. However, if approved by Original Medicare, it provides valuable assistance in covering out-of-pocket costs from glaucoma treatment.

Medigap could be worth looking into depending on the situation, especially when facing a glaucoma diagnosis and potential surgery. If you’re unsure of your coverage or costs, always contact Medicare or your plan provider for more information. There are people available to answer your Medicare questions.

Conclusion

Navigating Medicare regarding “Does Medicare cover glaucoma surgery?” can feel complex. Remember that while Medicare typically helps with part of the costs of glaucoma testing (especially for those at higher risk) and often covers some treatments (certain lasers and eye drops), it may not cover everything. If you end up needing surgery, prepare for out-of-pocket costs.

Factors like whether a procedure is deemed “medically necessary” come into play, so always check with Medicare to understand your coverage and plan accordingly. Reading the fine print regarding your prescription drug coverage and vision services will also give you a better picture of your coverage. Remember, taking proactive steps to maintain good eye health can help protect your vision and manage the impact of glaucoma on your life.

FAQ’s About Does Medicare Cover Glaucoma Surgery?

Does Medicare Cover Glaucoma Testing?

Medicare considers glaucoma testing a necessary service. But there’s a catch. Medicare might only cover your testing if your doctor thinks it’s medically reasonable. They also need to be enrolled in Medicare. This usually means you need certain risk factors or symptoms.

Medicare Part B helps pay for these glaucoma tests:

Ophthalmoscopy
Tonometry
Visual field testing
Gonioscopy
Optic nerve imaging

You usually pay 20% of the Medicare-approved amount for these tests if your doctor accepts assignment. This means they accept the Medicare payment as full payment. However, you might have to pay your Part B deductible. This is the amount you pay for covered healthcare before Medicare kicks in.

Does Medicare Cover Laser Eye Surgery for Glaucoma?

You bet Medicare can help cover glaucoma laser surgery, but it depends. Medicare usually steps in when a doctor says surgery is medically necessary. This means the surgery isn’t just for better vision – it’s to treat or slow down your glaucoma.

When we say “Medicare,” we’re talking about Part B. Think of it as the part that handles doctor visits and outpatient care. All Medicare Advantage plans cover Part B service, too. If your ophthalmologist recommends laser surgery and it checks out as medically necessary, Part B might cover things like:

The surgery itself
Prep and recovery care right there at the facility
Follow-up appointments with your doctor

But remember, Medicare usually takes a little bit off the top. It’s called a deductible, and you pay that first. After that, you might have a copay or coinsurance, your share of the cost.

Does Medicare pay for Glaucoma treatment?

If your doctor says it’s medically necessary, Medicare usually helps pay for glaucoma treatment, including surgery. This means the treatment is needed to diagnose or treat your glaucoma and prevent it from getting worse. Glaucoma can cause vision loss, but treatment can slow that down.

Medicare Part B generally covers doctor visits, glaucoma tests, and some medications. If you need surgery, Part B often covers that in a hospital outpatient setting. But, if you need to stay in the hospital for the surgery, that’s where Medicare Part A usually steps in.

You might have some out-of-pocket costs like deductibles, copayments, or coinsurance. This can vary based on your situation and your Medicare Advantage Plan (Part C). Some people also have a Medicare Supplement Insurance plan (Medigap) to help cover those extra costs.