Medicare Coverage for Glaucoma and Macular Degeneration

Age-related eye diseases are among the most common causes of vision loss in people over 65. Glaucoma affects an estimated 3 million Americans, and age-related macular degeneration (AMD) affects another 20 million. Both conditions can cause permanent vision loss or blindness if untreated — and both require ongoing treatment that Medicare covers, though the coverage rules are specific and the cost-sharing can be significant.

Understanding how Medicare pays for eye care goes well beyond simple vision coverage. The treatment for wet macular degeneration in particular involves expensive injected drugs administered in a physician’s office — drugs covered under Medicare Part B rather than Part D, with important cost-sharing implications.

General Medicare Eye Coverage: What’s Included and What Isn’t

Medicare’s standard vision exclusion means it does not cover routine eye exams for glasses or contacts, eyeglasses (except one pair after cataract surgery with IOL implantation), or contact lenses. These are not medically necessary services under Medicare’s definition.

However, Medicare does cover ophthalmology services that are medically necessary for diagnosed eye diseases:

• Office visits with an ophthalmologist for diagnosis and management of glaucoma, AMD, diabetic retinopathy, or other eye diseases — covered under Part B at 80/20 cost-sharing
• Diagnostic testing ordered and interpreted by an ophthalmologist (visual field testing, optical coherence tomography, fundus photography)
• Surgical procedures for eye diseases (laser treatments, vitreoretinal surgery, glaucoma surgery)
• Injections for wet AMD and diabetic macular edema (the highest-cost component of Medicare eye coverage)

Glaucoma Screening Under Medicare Part B

Medicare provides one free annual glaucoma screening for beneficiaries at high risk. To qualify, you must be in one of these high-risk categories:

• Diabetes
• Family history of glaucoma (parent or sibling with glaucoma)
• African Americans aged 50 or older
• Hispanic/Latino Americans aged 65 or older

The glaucoma screening includes a dilated eye examination and intraocular pressure measurement. If you qualify, this exam is covered at zero cost-sharing — no deductible, no copay. An ophthalmologist or optometrist (limited to this screening) can provide the exam.

If you do not fall into a high-risk category, a glaucoma exam billed under the glaucoma screening benefit is not covered. However, if you already have a glaucoma diagnosis, management visits are covered under standard Part B at 80/20 cost-sharing.

Glaucoma Diagnosis and Management

Once glaucoma is diagnosed, all ongoing management is covered under Part B:

• Ophthalmology office visits for disease monitoring
• Visual field testing (perimetry) — measures peripheral vision loss progression; covered under Part B
• Optical coherence tomography (OCT) of the optic nerve head — detects structural changes; covered under Part B
• Retinal nerve fiber layer analysis — covered under Part B

Glaucoma Medications Under Part D

Glaucoma is primarily treated with topical eye drops that lower intraocular pressure. These are covered under Medicare Part D:

• Prostaglandin analogs (latanoprost, bimatoprost, travoprost, tafluprost) — generic versions available at very low tier copays; the original brands (Lumigan, Travatan Z) may be on higher tiers
• Beta-blockers (timolol, betaxolol) — generic; very low cost
• Alpha-agonists (brimonidine) — generic; very low cost
• Carbonic anhydrase inhibitors (dorzolamide, brinzolamide; generic oral acetazolamide)
• Rho kinase inhibitors (netarsudil/Rhopressa, netarsudil-latanoprost/Rocklatan) — newer agents, covered under Part D but typically on higher tiers requiring prior authorization

For patients with multiple glaucoma medications, the $2,000 Part D out-of-pocket cap (2025) limits annual drug cost exposure regardless of medications prescribed.

Laser Treatment for Glaucoma

When eye drops are insufficient or poorly tolerated, laser treatment can lower intraocular pressure. Medicare covers two primary laser procedures under Part B:

Selective Laser Trabeculoplasty (SLT)

SLT targets the trabecular meshwork (the eye’s drainage tissue) with a low-energy laser to improve fluid outflow and lower pressure. It is increasingly used as a first-line treatment rather than eye drops, as evidence shows comparable efficacy with better compliance. SLT is an outpatient procedure performed in an ophthalmologist’s office or outpatient surgical center, covered under Part B at 20% coinsurance after the deductible.

Laser Peripheral Iridotomy (LPI)

For angle-closure glaucoma or narrow-angle glaucoma, an LPI creates a small opening in the peripheral iris to improve aqueous humor drainage. It is also performed in an outpatient setting and covered under Part B.

Cyclophotocoagulation

For severe, refractory glaucoma, laser cyclophotocoagulation reduces intraocular pressure by treating the ciliary body that produces aqueous humor. Covered under Part B.

Glaucoma Surgery

When laser treatment and medications fail to control pressure, surgical intervention may be needed:

• Trabeculectomy: traditional glaucoma filtration surgery; covered under Part A if inpatient, Part B if outpatient
• Minimally invasive glaucoma surgery (MIGS) — iStent, Hydrus Microstent, Kahook Dual Blade, Goniotome: these newer procedures are typically performed at the time of cataract surgery; covered under Part B
• Glaucoma drainage devices (Baerveldt, Ahmed, Molteno implants): tube shunt surgery for advanced cases; covered under Part B

Age-Related Macular Degeneration (AMD)

AMD is the leading cause of severe vision loss in people over 60. It affects the macula — the central part of the retina responsible for sharp, detail vision — and comes in two forms:

• Dry AMD (90% of cases): gradual drusen accumulation and geographic atrophy with no current cure; progression may be slowed by AREDS2 supplements (not Medicare-covered as they are dietary supplements)
• Wet AMD (10% of cases): abnormal blood vessel growth (choroidal neovascularization) leaking fluid or blood under the macula; causes rapid, severe central vision loss; highly treatable with anti-VEGF injections

Diagnostic Testing for AMD

Medicare Part B covers:

• Optical coherence tomography (OCT) of the macula — the primary imaging modality for monitoring AMD; detects subretinal fluid indicating wet AMD activity; covered under Part B
• Fluorescein angiography — dye-based imaging of retinal vasculature; covered under Part B
• Indocyanine green (ICG) angiography — imaging of the choroidal vasculature; covered under Part B
• Fundus photography — documentation of drusen pattern and geographic atrophy; covered under Part B

Anti-VEGF Injections: The Core Treatment for Wet AMD

Anti-VEGF (anti-vascular endothelial growth factor) injections are the standard of care for wet AMD. They suppress abnormal blood vessel growth and are typically administered monthly or every 1–3 months long-term. These drugs are covered under Medicare Part B — not Part D — because they are administered by injection in a physician’s office.

This distinction matters enormously for cost. Part B covers these drugs at 80/20 cost-sharing (patient pays 20% of the Medicare-approved amount after the Part B deductible). With no out-of-pocket cap under Original Medicare, and with anti-VEGF drugs costing $1,000–$2,000 per injection, a patient receiving 10 injections per year faces $2,000–$4,000 per year in Part B coinsurance before Medigap.

The currently available anti-VEGF drugs covered under Part B:

Bevacizumab (Avastin) deserves special mention. It is a cancer drug used off-label for AMD and DME (diabetic macular edema) at dramatically lower cost than the branded anti-VEGF drugs — approximately $60 per dose versus $1,900+. Clinical trials (CATT study) showed non-inferiority to ranibizumab. Many Medicare-enrolled retinal specialists use bevacizumab as first-line treatment for cost reasons. If your physician prescribes Eylea or Lucentis and cost is a concern, ask whether bevacizumab is appropriate for your case.

What Medigap Means for Anti-VEGF Costs

If you have Medigap Plan G or Plan N, your Part B coinsurance for anti-VEGF injections is covered:

• Plan G: Zero coinsurance after the annual Part B deductible ($257 in 2025) — your anti-VEGF injections are effectively free after the deductible
• Plan N: 20% coinsurance is covered, but you pay a copay of up to $20 per office visit — still dramatically lower than without Medigap

For a wet AMD patient receiving 10 Eylea injections per year, Medigap Plan G saves approximately $3,800 in coinsurance annually. For patients who will need ongoing anti-VEGF treatment for years (which is typical), Medigap is extraordinarily valuable.

Beneficiaries with Medicare Advantage receive anti-VEGF injections through their MA plan. Plans may require prior authorization for each treatment course, and some plans have in-network restrictions on which retinal specialists you can see. Check your MA plan’s prior authorization requirements and specialist network before beginning treatment.

Diabetic Retinopathy and Diabetic Macular Edema

Beneficiaries with diabetes are eligible for an annual dilated eye exam under Part B (80/20 cost-sharing) specifically for diabetic retinopathy screening. Beyond screening, Medicare covers:

• Laser photocoagulation (panretinal or focal) for diabetic retinopathy: covered under Part B
• Anti-VEGF injections for diabetic macular edema (DME): covered under Part B at the same reimbursement rates as for AMD (all the same drugs — Eylea, Vabysmo, bevacizumab)
• Intravitreal steroid injections (triamcinolone, Ozurdex implant, Iluvien implant) for DME: covered under Part B

Patients with both AMD and diabetic macular edema receiving anti-VEGF injections in both eyes face particularly high Part B coinsurance exposure — another strong argument for Medigap.

Cataract and Eye Coverage Interaction

Cataract surgery is the most common Medicare procedure, and many AMD and glaucoma patients undergo cataract surgery as well. Cataract surgery and MIGS glaucoma surgery are frequently combined in a single procedure. See our detailed guide to Medicare coverage for cataract surgery for the cost-sharing framework for standard versus premium IOL lenses.

Low Vision Rehabilitation

When AMD or glaucoma results in vision loss that cannot be corrected by surgery or injections, low vision rehabilitation helps patients maximize their remaining functional vision. Medicare covers low vision rehabilitation services under Part B:

• Low vision evaluation by a low vision specialist (ophthalmologist or optometrist with low vision training): covered under Part B at 80/20
• Occupational therapy for low vision: covered under Part B — therapists trained in low vision teach adaptive techniques for daily activities
• Low vision aids training: covered as occupational therapy

Note: Medicare does not cover the low vision devices themselves (magnifiers, telescopic lenses, CCTV readers) — only the professional evaluation and training services.

Medicare Advantage and Supplemental Vision Benefits

Many Medicare Advantage plans include supplemental vision benefits beyond Original Medicare. These typically cover:

• Annual routine eye exam (not covered by Original Medicare)
• Allowance toward eyeglasses or contact lenses (usually $100–$300 per year)

However, these supplemental benefits come with trade-offs. MA plans restrict specialist access via networks and often require prior authorization for the high-cost medical services (anti-VEGF injections, laser procedures) that actually dominate the cost for patients with glaucoma or AMD. The supplemental vision benefit is worth far less than the coinsurance protection that Medigap Plan G provides for serious eye disease management.

Planning Ahead for Eye Disease Costs

The financial impact of glaucoma and wet AMD on Medicare beneficiaries depends heavily on coverage choices:

Original Medicare alone: No out-of-pocket cap. Anti-VEGF injections at 20% coinsurance ($4,000+/year for 10 injections) are the primary cost driver. Part B deductible ($257/year) is minimal by comparison.

Original Medicare + Medigap Plan G: Anti-VEGF injections effectively free after the $257 Part B deductible. Laser procedures, surgeon fees, and office visits covered at no additional cost-sharing. The most financially protective option for patients requiring long-term treatment.

Medicare Advantage: Premium savings come with network restrictions and prior authorization requirements that can significantly affect access to retinal specialists and timely treatment. For a condition where delay in anti-VEGF treatment risks permanent vision loss, prior authorization delays carry real clinical consequences.

For detailed cost comparison between coverage options, see Medigap plans compared and Medicare Advantage vs. Original Medicare. For patients managing multiple chronic conditions with high Part B drug costs, the Medicare Part B vs. Part D drug coverage guide explains why injected drugs are under Part B and what that means for your cost-sharing strategy. Beneficiaries managing AMD and diabetes simultaneously should also review Medicare coverage for diabetes for the full picture of diabetic complications coverage.