Does Medicare Cover Treatment for Macular Degeneration? 

Macular degeneration, also known as age-related macular degeneration, occurs more commonly in people who are older than 60. And in the United States, over 20 million adults have been diagnosed with it.  

If you have a family history of macular degeneration, you might have a higher risk of developing the disease. But there are other common risk factors for developing macular degeneration outside of heredity that include:

  • Age
  • Obesity
  • Smoking 
  • Hypertension
  • Diet high in saturated fat
  • Being Caucasian 

Macular degeneration happens when the macula of the retina begins to deteriorate. Because the macula is responsible for sending images from the optic nerve to the brain, when it deteriorates, the brain can’t recognize those images. Some of the most common symptoms of macular degeneration include: 

  • Reduced vision in low light
  • Blurry vision
  • Difficulty distinguishing color
  • Loss of vision
  • Wavy vision
  • Blank or dark spots in central vision

There are two types of macular degeneration: dry and wet; and there are three stages: early, intermediate, and advanced. The type of treatment your physician suggests depends on the type and stage of your disease. 

Prescription drugs are available to treat wet age-related macular degeneration known as anti-vascular endothelial growth factor (anti-VEGF), which the physician injects directly into the eye in most cases. These drugs block a protein that’s responsible for producing new blood vessels, and in many instances, they help improve vision, but they don’t cure the disease. 

If your physician or ophthalmologist has diagnosed age-related macular degeneration, and prescribes anti-VEGF injections, your Medicare insurance may help you cover a portion of the expenses.

Does Medicare cover treatment for macular degeneration?

If your physician or ophthalmologist, who accepts Medicare assignment, diagnoses macular degeneration and prescribes injections as a medically necessary treatment for your condition, you may be eligible for coverage from your Medicare insurance. 

Because the injections must be administered by your physician either in his office or in a hospital outpatient facility, they are covered by Medicare Part B (medical insurance). 

Some examples of injectable prescription drugs that Medicare Part B covers to treat wet age-related macular degeneration are:

  • Eylea
  • Lucentis (ranibizumab) 
  • Brolucizumab (Beovu)
  • Avastin

Original Medicare Part B pays for 80 percent of the cost of the drugs and the doctor’s services when they are administered by a physician who accepts Medicare assignment, and in a medical facility that is also Medicare affiliated. You pay 20 percent of the final approved cost after paying your annual Part B deductible. If you get the injections in an outpatient facility, you may also be responsible for a coinsurance charge. 

If you have Medicare Advantage (Part C), your plan provider must provide the same benefits as Original Medicare Parts A and B. Your plan may require that you use medical providers and facilities that are in your plan’s network, and your coinsurance charges may be different than Medicare Part B charges. 

How much do treatments for macular degeneration cost without Medicare benefits?

If you don’t have Medicare coverage, your costs for treatment vary depending on the type of drug, the amount, and the frequency of your treatments. The national average cost in the United States is between $9,000 and $65,000 for two years of regular treatments with prescription drugs that are injected directly into the eye. 

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