Does Medicare Cover Macular Degeneration Treatment?
Medicare Part B will cover some diagnostic tests used to detect macular degeneration as well as certain treatments to prevent or slow the progression of the disease. Age-related macular degeneration is the leading cause of vision loss in people over age 60.
Medicare and Macular Degeneration Tests
Medicare Part B will cover some diagnostic tests used to detect age-related macular degeneration (AMD). Doctors can identify the condition with a dilated eye exam or with an optical coherence tomogram, which allows them to look at the back of your eye and the macula.
You will be responsible for 20 percent of the Medicare-approved cost of the test after you have paid your Part B deductible. Check with your plan and your doctor or health care provider to ensure that the type of test they plan to administer is covered.
Medicare Part B covers only medically necessary exams and procedures, so your doctor or health care provider must verify that you need to be tested for AMD for Medicare to cover it.
Does Medicare Cover Eye Injections for Macular Degeneration?
According to Harvard Medical School, there are currently no treatments approved by the Food and Drug Administration for dry age-related macular degeneration, the more common and less serious type of AMD.
You can prevent dry AMD from getting worse over time by exercising, eating healthy foods and quitting smoking. Your doctor will likely just monitor its progression.
Treatments are available for wet AMD, the more severe type of AMD, and Medicare will cover some of the treatments. Wet AMD is most often treated with an injection into the eye.
Regular injections can slow your vision loss, but there is no way to reverse it. Medicare Part B will cover 80 percent of the Medicare-approved costs, leaving you to pay 20 percent after the deductible has been met.
It is very important to talk with your health care provider about the brand of drug that will be used to treat your AMD. Lucentis (ranibizumab), which is injected into the eye, is a commonly used medication that can cost up to $2,000 a dose, and injections are often needed every month.
According to the Chicago Tribune, the drug Avastin (bevacizumab) can cost as little as $50 a dose. Avastin was originally used to treat cancer but can also treat wet AMD in small doses. Check with your doctor or health care provider to find out which drug you need.
If you receive these injections in a hospital outpatient setting, you will also have to pay a copayment. Medicare Advantage plans, which often include additional vision coverage, could help with these costs.
What Is Age-Related Macular Degeneration?
Age-related macular degeneration is a disease in your eye that leads to vision loss. It affects the macula, which is responsible for your central vision. Your central vision allows you to see things in sharp detail.
AMD won’t result in complete blindness, but the disease can make your vision so blurry that eventually, you might not be able to drive, read a book or see images on TV.
According to the National Eye Institute, older people and those who smoke are the most at risk for AMD, which can often develop slowly over time. At first, you may just notice a slight blurriness in the center of your vision. Eventually, this blurry spot can get bigger, and the brightness of your vision will start to fade.
- Dry AMD
- This is the less severe of the two types and results from the cells of the macula breaking down. It can lead to significant vision loss over time.
- Wet AMD
- This rarer form progresses from dry AMD and makes up only 10 percent to 15 percent of all cases. Blood vessels build up in the back of your eye and eventually break, releasing blood into your macula and severely impacting your vision.
9 Cited Research Articles
- U.S. National Library of Medicine. (2021, April 9). Macular Degeneration. Retrieved from https://medlineplus.gov/maculardegeneration.html
- Harvard Medical School. (2020, November 24.) Age-Related Macular Degeneration: Early Detection and Timely Treatment May Help Preserve Vision. Retrieved from https://www.health.harvard.edu/blog/age-related-macular-degeneration-early-detection-and-timely-treatment-may-help-preserve-vision-2020112421362
- U.S. National Library of Medicine. (2020, October 20). Lucentis — Ranibizumab Injection, Solution. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=de4e66cc-ca05-4dc9-8262-e00e9b41c36d#section-1.1
- U.S. National Library of Medicine. (2020, August 18). Age-Related Macular Degeneration. Retrieved from https://medlineplus.gov/genetics/condition/age-related-macular-degeneration
- National Eye Institute. (2020, August 17). Age-Related Macular Degeneration. Retrieved from https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration
- University of Michigan Medicine. (2019, February 19). Wet vs. Dry AMD: What’s the Difference? Retrieved from https://healthblog.uofmhealth.org/Wet-vs-Dry-Macular-Degeneration-AMD-perfcon
- Lam, A. (2015, December 11). Why Do Doctors Choose a $2,000 Cure When a $50 Is Just as Good? Retrieved from https://www.chicagotribune.com/opinion/commentary/ct-pharmaceutical-drug-costs-20151211-story.html
- U.S. Department of Health and Human Services. (2012, April). Medicare Payments for Drugs Used To Treat Wet Age-Related Macular Degeneration. Retrieved from https://oig.hhs.gov/oei/reports/oei-03-10-00360.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Macular Degeneration Tests & Treatment. Retrieved from https://www.medicare.gov/coverage/macular-degeneration-tests-treatment