Glaucoma: Does Medicare Cover Your Test?

Did you know that glaucoma is the second leading cause of blindness in the world?  Any many Americans are unfamiliar with the disease, the effects, and how to take preventative measures (Optic Nerve Tests) against the eye disease.  What is one of the high-risk groups?  People age 60 and older.  Today we’re sharing what you should know about Glaucoma and how Medicare helps cover Glaucoma tests.

According to a study from the Glaucoma Research Foundation, less than half of all adult Americans are receiving a dilated eye exam (the best and most effective way to detect glaucoma) once every two years.

What is Glaucoma?

  • It is a progressive eye disease that causes irreversible vision loss through damage to the optic nerve.
  • Some forms of the disease have symptoms; however, some do not.
  • There is no cure for the various types, but there are medications and surgeries to help prevent further loss of vision.
  • Approximately only 10% of people with glaucoma receive proper treatment.
  • Regular prescription eye tests do not detect glaucoma and other eye diseases.
  • African-Americans are 15 times more likely to be visually impaired than Caucasians.
  • Other high-risk groups: family members of those already diagnosed, diabetics, and those who are severely near-sighted.

Normal eye next to an eye with Glaucoma, optic nerve tests

How does Medicare help cover testing?

Glaucoma tests are covered once a year for individuals with Medicare Part B that are considered high-risk.  Medicare defines high-risk as being diabetic, having a family history of the eye disease, or being an African-American and age 50 or older, or a Hispanic American age 65 or older.

Helpful Tip: Whenever a test, screening, or item is deemed “medically necessary” by your doctor, it will be covered in some portion by Medicare Part B.  

Was your claim denied by Medicare?  Learn how to appeal a Medicare Decision when a claim is denied.

During an exam, your ophthalmologist will:

  • Measure your eye pressure
  • Inspect your eye’s drainage angle
  • Examine your optic nerve for damage
  • Test your peripheral (side) vision
  • Take a picture or computer measurement of your optic nerve
  • Measure the thickness of your cornea

What are the costs with Original Medicare?

You pay 20% of the Medicare-approved amount, and your Medicare Part B deductible applies. If you receive outpatient services, you also will have a co-pay. The costs of specific tests and services can vary depending on any additional insurance you have, where you get the tests done, and how much your doctor charges. It is recommended that people have a conversation at least once a year with their doctor in regards to their eye health and what preventative measures they should take.

Helpful Tip: So when receiving your doctor’s recommendation for a glaucoma screening (Optic Nerve Test), be sure to ask about what you might owe.

What Can I Do to Prevent Glaucoma?

  • Regular eye exams
    • In general, a check should be done:
      • before age 40, every two to four years
      • from age 40 to age 54, every one to three years
      • from age 55 to 64, every one to two years
      • after age 65, every six to 12 months
  • Exercise
    • A regular program of moderate exercise will benefit your overall health, and studies have shown that moderate exercise such as walking or jogging three or more times every week can have an IOP lowering effect.
  • Protect Your Eyes
    • Wearing protective eyewear is important when engaged in sports activities or home improvement projects.
    • Eye injuries can result in traumatic glaucoma

Helpful Tip: Remember, regular comprehensive eye exams are the best form of prevention against eye disease.

Additional Resources

[1] http://www.glaucoma.org/glaucoma/glaucoma-facts-and-stats.php
[2] https://www.medicare.gov/coverage/glaucoma-tests.html


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