Does Medicare Cover Macular Degeneration?

Medicare does cover some macular degeneration tests and treatments, including treatment with certain specific injected drugs.

As many as 11 million Americans have some form of age-related macular degeneration (AMD), and the condition is the leading cause of vision loss in people age 60 and over.1 Learn more about your Medicare coverage options for macular degeneration.

Woman wearing glasses and smiling outdoors

Does Medicare cover eye exams for macular degeneration?

Medicare Part B (medical insurance) may cover your preventive or diagnostic eye exam for macular degeneration. In order for Medicare to cover your exam, your doctor must determine that your vision test is medically necessary to diagnose or treat AMD.

After you meet your Part B deductible ($185 per year in 2019), you will typically pay a Part B copayment for your exam. The Part B copay is 20 percent of the Medicare-approved amount for your doctor’s services.

Will Medicare help pay for macular degeneration treatment?

Macular degeneration is most often treated with drugs that are injected into the blood or the eye itself.

Medicare Part B may help cover injectable treatments for beneficiaries who have AMD. These treatment options can include:

  • Lucentis
  • Avastin
  • Macugen
  • Eylea
  • Verteporfin
  • Aflibercept
  • Pegaptanib

If your treatment is offered in an outpatient setting, you will typically pay the Part B copayment of 20 percent of the Medicare-approved amount for the treatment drug, after meeting your Part B deductible.

Many Medicare Advantage plans offer additional vision benefits

Medicare Advantage plans (Medicare Part C) provide the same benefits as Original Medicare (Part A and Part B), and most plans also offer additional benefits not covered by Original Medicare.

Two common extra benefits included in Medicare Advantage plans is vision coverage and prescription drug coverage.

With a Medicare Advantage plan, your vision tests and treatment for macular degeneration will be covered the same way that they would be covered by Original Medicare. Plus, many plans will help cover the cost of routine eye exams, eyeglasses and contact lenses as well, which are not covered by Original Medicare.

Learn more about how a Medicare Advantage plan could help you save money on your health care costs. Plans that offer $0 premiums and $0 deductibles may be available where you live, though they may not be offered in all locations.

To compare your plan options, call a licensed insurance agent at TTY Users: 711 24 hours a day, 7 days a week.  

 

1 BrightFocus Foundation. Age-Related Macular Degeneration: Facts & Figures. (Updated Jan. 5, 2016). Retrieved from www.brightfocus.org/macular/article/age-related-macular-facts-figures.

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