Does Medicare Cover Macular Degeneration Treatments?

Are you trying to understand, “does Medicare cover macular degeneration” treatments? Look no further. This article cuts through the confusion to outline Medicare’s role in managing this eye condition, including coverage of tests, medications, and procedures.

While delving into specifics about out-of-pocket costs and additional plans, we avoid complex jargon—ensuring you get the straightforward facts needed to navigate your healthcare options.


Key Takeaways

  • Medicare provides coverage for treatments of macular degeneration, including injectable drugs, laser therapy, photodynamic therapy, and surgery; with Medicare Part B specifically covering doctors’ visits, medications, surgery, and certain diagnostic tests after meeting the deductible.


  • Medicare Advantage plans offer similar coverages to Original Medicare for macular degeneration care and may include extra benefits such as vision and prescription drugs; while the specific coverage for eye injections and other services varies by plan.


  • Out-of-pocket expenses for macular degeneration treatment can be mitigated through Medicare Supplement plans, which help reduce the costs not covered by Medicare, and there are various organizations and alternative treatments that support management of the condition.

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Understanding Macular Degeneration

Macular degeneration is a condition characterized by the blurring of central vision due to the deterioration of macular cells. There are two types, with dry macular degeneration, also known as AMD, being the most common. It is marked by the thinning of the macula due to aging and progresses in three stages – early, intermediate, and late.

This condition significantly affects central vision, making it difficult for individuals to read and recognize faces, among other things. It can be attributed to age-related changes or genetics, and its symptoms include blurry central vision and difficulty distinguishing colors. Diagnosing and monitoring the condition requires regular macular degeneration tests.


Understanding Macular Degeneration

Medicare’s Role in Macular Degeneration Treatment

Medicare plays a pivotal role in covering a variety of treatments for macular degeneration, including:


  • Injectable drugs
  • Laser therapy
  • Photodynamic therapy
  • Surgery


This coverage allows for better comprehension of potential expenses and ensures that individuals have access to the necessary diagnosis and treatment for this condition.


Medicare Part B Coverage for Macular Degeneration

Medicare Part B offers a variety of services to macular degeneration patients, including:


  • Doctor visits
  • Medications
  • Surgery
  • Routine eye exams
  • Injections for treatment
  • Coverage for specific diagnostic tests and treatment related to macular degeneration


After meeting the annual Part B deductible, patients are responsible for covering 20% of the diagnostic exam cost. Medicare covers the remaining 80%, which is the medicare pay portion. In an outpatient setting, individuals typically make a 20% copayment of the Medicare-approved amount once the Part B deductible has been met.


Medicare Advantage Plans and Macular Degeneration

A Medicare Advantage plan is a health plan approved by Medicare and offered by a private company. It can provide coverage for all original Medicare services, and some plans offer additional benefits like:


  • Prescription drugs
  • Vision
  • Hearing
  • Dental
  • Wellness services


Medicare Advantage plans provide similar coverage to Original Medicare for macular degeneration, encompassing doctor visits, medications, and surgery. Some plans also include supplementary vision care benefits, such as macular degeneration injections coverage.

To answer the common question, “does medicare cover macular degeneration?”, the deductible and copays for macular degeneration screening with Medicare Advantage plans depend on the specific plan you have.

Specific Treatments Covered by Medicare

Part B Medicare coverage includes eye injections for age-related macular degeneration and diabetic retinopathy, such as anti-VEGF injections for these conditions. These injections are provided for under Medicare’s coverage.


Eylea, Lucentis, and Beovu Injections

Anti-VEGF agents are pharmaceuticals employed to decelerate the advancement of wet macular degeneration. Medicare Part B provides coverage for various medications used for anti-VEGF injections, such as Eylea, Lucentis, and Beovu.


Is macular degeneration covered by medical insurance



Eylea is used for the treatment of wet age-related macular degeneration (AMD) and various other retinal conditions. Lucentis, also known as ranibizumab, is utilized to inhibit the growth of abnormal blood vessels in the eye that can leak and impact vision, leading to vision impairment in cases of wet macular degeneration and diabetic eye disease.

Beovu serves as a pharmaceutical intervention for neovascular (wet) AMD and has received FDA approval for this specific therapeutic application.

Out-of-Pocket Costs and Supplemental Plans

Medicare Supplement plans, which help reduce annual medical costs including those associated with treatments for macular degeneration, are beneficial in alleviating the out-of-pocket expenses not covered by Medicare.


How much do injections for macular degeneration cost



The cost of a Medicare Supplement plan for macular degeneration treatments varies based on the chosen plan and the level of coverage it offers.

The most cost-effective Medicare Supplement plan for macular degeneration treatments can be found using tools like MedicareFAQ’s online rate comparison form or by consulting with a licensed broker. Assistance with comprehending and selecting the appropriate Medicare coverage can be obtained by completing an online request form or contacting Medicare experts via phone.

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Alternative Treatments and Resources

For managing macular degeneration, the following lifestyle modifications are advised to prevent factors that kills macular cells:


  • Incorporate a diet rich in dark leafy greens, omega-3 fatty acids, and antioxidants
  • Cease smoking
  • Use sunglasses or protective eyeglasses for sun protection
  • Reduce exposure to bright light from screens


Traditional Chinese medicine remedies and Ayurvedic approaches can potentially aid in managing macular degeneration. Additionally, acupuncture is a natural treatment option that is utilized to decelerate the progression of the disease.

In addition to Medicare, individuals can explore health insurance plans and seek assistance from organizations like The Macula Vision Research Foundation and Bright Focus Foundation for coverage and financial support for macular degeneration treatments.

The National Eye Institute offers educational materials, and there are support groups that provide emotional and practical assistance for individuals dealing with macular degeneration.

Navigating Vision Services with Medicare

Medicare provides coverage for routine eye exams or other vision-related costs only in special situations. Visits to an optometrist are not covered by Medicare for routine vision care or eye exams.


Is eylea injection covered by medicare



To ascertain whether a specific vision service is included in Medicare coverage, it is advisable to consult with your physician or healthcare provider, as Medicare only covers eye care in specific circumstances.

How to Maximize Your Healthcare Coverage for Macular Degeneration

Medicare Part B covers a variety of treatments such as doctor visits, medications, and surgery, ensuring patients have access to necessary care for macular degeneration. It typically covers up to 80% of the cost for specific injectable treatments.

Selection of a Medicare plan for macular degeneration treatment calls for careful considerations. Here are some steps to follow:


  1. Ensure the plan covers injections for the condition.
  2. Review the coverage for diagnostic tests and other treatments under Part B.
  3. Consider the potential costs associated with the plan as well as the percentage of costs you’ll be responsible for.
  4. The plan should cover doctor visits, medications, and surgery.
  5. Compare different plans to find the most suitable one for your needs.
  6. Don’t hesitate to seek advice from healthcare professionals for further guidance.


A supplemental Medicare plan, also known as a Medigap plan, can provide Medicare cover for expenses not covered by Original Medicare, effectively bridging the gaps in coverage for treatments related to macular degeneration.


This blog post has provided an in-depth look into the world of macular degeneration and how Medicare plays a crucial role in its treatment. Through understanding the condition, exploring Medicare’s coverage, alternative treatments, and resources, we hope you are better equipped to navigate your healthcare options effectively.

Frequently Asked Questions



Is macular degeneration covered by Medicare Part B?

Yes, Medicare Part B covers both screening and treatment for macular degeneration if deemed medically necessary by a healthcare professional.


How much does it cost to treat macular degeneration?

The cost of treating macular degeneration can vary widely, ranging from $8,814 to $23,400 per year, or $32,491 to $70,200 after 3 years of treatment. These costs depend on factors such as the medication used and treatment frequency.


Is macular degeneration considered a medical condition?

Yes, macular degeneration is considered a medical condition that can result in severe loss of central vision, but people rarely go blind from it. Age, smoking, high blood pressure, and diet are risk factors for AMD.


What is macular degeneration?

Macular degeneration is a condition that causes blurring of central vision and affects the ability to read and recognize faces, with two types – dry and wet. Dry macular degeneration is the most common type.


What additional benefits do Medicare Advantage Plans offer?

Medicare Advantage Plans offer additional benefits such as prescription drugs, vision, hearing, dental, and wellness services, on top of covering all original Medicare services. This can provide comprehensive healthcare coverage for individuals.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.