Does Medicare Cover Glaucoma Eye Drops?
If you’ve been diagnosed with glaucoma, it means that you may have vision loss due to optic nerve damage. The most common type of glaucoma is open-angle glaucoma, a slow-developing condition that causes peripheral vision loss initially, loss of central vision, and finally blindness if it isn’t treated.
In the United States, approximately two million people have glaucoma. It’s more common in the over-65 age group and is the leading cause of blindness for African Americans.
You might be at a higher risk for getting glaucoma if you have high eye pressure, a family history of the disease, or you use steroid medications. However, if your ophthalmologist detects glaucoma and treats it right away, it’s possible to stop or slow down the disease’s progression. Treatment options include laser, surgery, or certain medications including eye drops.
Some types of commonly prescribed medications for glaucoma include:
- Beta-adrenergic antagonists
- Prostaglandin analogues
- Adrenergic agonists
- Carbonic anhydrase inhibitors
- Parasympathomimetic agents
- Osmotic agents
Because treating glaucoma is vital to your vision, it’s important to get tested early, and to begin taking any medications that your physician orders. Having Medicare coverage for glaucoma testing and medications can help you cover some of your expenses.
How does Medicare cover glaucoma care?
Glaucoma screening
Original MedicarePart B (medical insurance) covers 100 percent of the cost of glaucoma screening exams if your physician orders them as medically necessary, and a Medicare-affiliated health care provider who’s legally licensed in your state performs them.
Part B covers glaucoma testing every 12 months if you are at high risk for developing glaucoma because:
- You’re diabetic
- You have a family history of glaucoma
- You’re Black and over 50
- You’re Hispanic and over 65
If you have coverage through a Medicare Advantage (Part C)plan, your provider must cover the same benefits that you’d be eligible for through Original Medicare Parts A and B coverage. Depending on the type of Medicare Advantage plan you have, you may need to use specific health care providers and medical laboratories that are approved by your plan to get coverage. Your provider can give you more detailed information about restrictions and allowances regarding your plan if you aren’t sure.
Glaucoma medications
Most medications prescribed by physicians for glaucoma treatment are covered by Medicare prescription drug (Part D) plans. If you don’t have Part D coverage, you can enroll in a stand-alone Part D Prescription Drug Plan if you have Original Medicare Parts A and B. If you prefer having all parts of Medicare bundled into one plan, you can enroll in a Medicare Advantage plan that includes prescription drug coverage, known as an MAPD plan.
Even though most Medicare prescription drug plans cover prescription medications and eye drops necessary to treat glaucoma, every Part D plan covers different drugs on their formularies (lists of covered drugs). You should check your plan’s formulary to ensure you’re covered before going to the pharmacy to pick up your prescription. If your Part D plan doesn’t cover your medication, you can ask your physician if there are other options. You can change your Part D coverage during the appropriate enrollment periods.
Whether you have a stand-alone Medicare Part D plan, or you have an MAPD, how much you pay for your glaucoma medication depends on the type of drug your physician prescribes and its dosage, on which drug tier your plan categorizes it, and how much the plan charges for copayments per tier.