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.

Christian Simmons, writer and researcher for RetireGuide
  • Written by
    Christian Simmons

    Christian Simmons

    Financial Writer

    Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.

    Read More
  • Edited By
    Lee Williams
    Lee Williams, senior editor for RetireGuide.com

    Lee Williams

    Senior Financial Editor

    Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.

    Read More
  • Reviewed By
    Aflak Chowdhury
    Aflak Chowdhury

    Aflak Chowdhury

    Medicare Expert

    Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.

    Read More
  • Published: June 2, 2021
  • Updated: May 8, 2023
  • 3 min read time
  • This page features 9 Cited Research Articles
Fact Checked
Fact Checked

A licensed insurance professional reviewed this page for accuracy and compliance with the CMS Medicare Communications and Marketing Guidelines (MCMGs) and Medicare Advantage (MA/MAPD) and/or Medicare Prescription Drug Plans (PDP) carriers’ guidelines.

Cite Us
How to Cite RetireGuide.com's Article

APA Simmons, C. (2023, May 8). Does Medicare Cover Macular Degeneration Treatment? RetireGuide.com. Retrieved September 22, 2023, from https://www.retireguide.com/medicare/services/vision/macular-degeneration/

MLA Simmons, Christian. "Does Medicare Cover Macular Degeneration Treatment?" RetireGuide.com, 8 May 2023, https://www.retireguide.com/medicare/services/vision/macular-degeneration/.

Chicago Simmons, Christian. "Does Medicare Cover Macular Degeneration Treatment?" RetireGuide.com. Last modified May 8, 2023. https://www.retireguide.com/medicare/services/vision/macular-degeneration/.

Why Trust RetireGuide.com
Why You Can Trust Us

Content created by RetireGuide and sponsored by our partners.

Key Principles

RetireGuide’s mission is to provide seniors with resources that will help them reach important financial decisions that affect their retirement. Our goal is to arm our readers with knowledge that will lead to a healthy and financially sound retirement.

We’re dedicated to providing thoroughly researched Medicare information that guides you toward making the best possible health decisions for you and your family.

RetireGuide LLC has partnerships with Senior Market Sales (SMS) and GoHealth.

Our partners are able to be reached through the phone numbers and/or forms provided on our website.

The content and tools created by RetireGuide adhere to strict Medicare and editorial guidelines to ensure quality and transparency.

Editorial Independence

While the experts from our partners are available to help you navigate various Medicare plans, RetireGuide retains complete editorial control over the information it publishes.

We operate independently from our partners, which allows the award-winning RetireGuide team to provide you with unbiased information.

Visitors can trust our inflexibility regarding our editorial autonomy. We do not allow our partnership to influence RetireGuide’s editorial content whatsoever.

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.

Two Types of Age-Related Macular Degeneration
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.
Last Modified: May 8, 2023

9 Cited Research Articles

  1. U.S. National Library of Medicine. (2021, April 9). Macular Degeneration. Retrieved from https://medlineplus.gov/maculardegeneration.html
  2. 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
  3. 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
  4. U.S. National Library of Medicine. (2020, August 18). Age-Related Macular Degeneration. Retrieved from https://medlineplus.gov/genetics/condition/age-related-macular-degeneration/
  5. 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
  6. 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
  7. 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
  8. 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
  9. U.S. Centers for Medicare & Medicaid Services. (n.d.). Macular Degeneration Tests & Treatment. Retrieved from https://www.medicare.gov/coverage/macular-degeneration-tests-treatment