Macular degeneration is the leading cause of vision problems for those 60 and older, affecting nearly 2 million Americans. Medicare covers necessary tests to diagnose age-related macular degeneration. Medicare Part B may also pay for injections to treat macular degeneration.
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A Medicare Part D Prescription Drug plan may cover macular degeneration medications. Coverage and costs depend on the kind of plan you have, the doctor, and the treatment.
Does Medicare Cover Macular Degeneration Injections?
Most therapy options for Macular Degeneration are injectable drugs that go into the blood or the eye itself. When treatment is outpatient, coverage falls under Medicare Part B. Macular Degeneration costs fall into two categories.
You may have tests to diagnose the disease and monitor its progress. Also, your doctor may suggest treatments that could slow down the degeneration process or even reverse some damage.
What Expenses for Macular Degeneration are Covered by Medicare?
Age-Related Macular Degeneration Screening
A doctor can diagnose early-stage macular degeneration by looking for medium-sized yellow deposits underneath the retina. These deposits are known as drusen. If the disease has advanced, specific tests will detect larger drusen and pigment changes in the retina.
Medicare will cover a Macular Degeneration screening only if your doctor decides it’s medically necessary to diagnose or treat the disease. Once you meet your annual Part B deductible, you’ll pay 20% of the cost of a diagnostic exam. If you have a Medicare Advantage plan, your deductible and copays will depend on your plan.
Treatments for Age-Related Macular Degeneration Covered by Medicare
Medicare Part B covers treatment for beneficiaries with age-related macular degeneration:
- Lucentis – approved by the FDA in June 2006 for treating the more high-level or “wet” form of macular degeneration
- Avastin – a cancer drug that is less expensive.
- Macugen – This treatment for AMD uses a therapeutic molecule to attack VEGF in the eye
- Eylea – Like Lucentis and Macugen, Eylea inhibits the action of VEGF in wet (neovascular) AMD
- Verteporfin (Visudyne) – ocular photodynamic therapy only for those patients who have new blood vessel growth under the retina in a pattern known as “predominantly classic“
- Implantable Miniature Telescope (IMT) – for patients with central blindness in both eyes also with no option for correction with eyeglasses, contact lenses, medication, or other eye surgery
- Aflibercept – recombinant protein treatment for wet AMD
- Pegaptanib – also used for treating wet AMD
Does Medicare Cover Wet Macular Degeneration Treatments?
Wet macular degeneration treatment consists of anti-VEGF injections into the eye. These help prevent blood vessels from forming behind the retina and leaking blood, serum, and lipids into the retina.
Further, leakage causes scarring and kills macular cells. However, there are several injectable drugs available, including Lucentis, Avastin, and Eylea. Each works in a somewhat different way.
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Consult with your doctor to see if Medicare will cover these treatments since there are many different factors that come into play.
Does Medicare Cover Eylea Injections?
Eylea is the brand name for the drug; also, it’s an injection to treat wet age-related macular degeneration. If your doctor determines treatment with Eylea is necessary, Part B will cover it. After you have met your Part B deductible, you pay 20% of the cost of the injections.
Does Medicare Cover Lucentis Injections?
Lucentis (ranibizumab) is another Anti-VEGF therapy for macular degeneration. Part B covers Lucentis injections.
Does Medicare Cover Beovu Injections?
Yes, the FDA has approved Brolucizumab injections for the treatment of Macular Degeneration. Therefore, Medicare will cover it.
How to Get Help Covering Macular Degeneration Treatments Under Medicare
Treatment for age-related macular degeneration can help preserve your eyesight and allow you to continue to drive, work, and participate in activities you enjoy. The injections are expensive. If your only healthcare coverage is Medicare, the out-of-pocket costs may be more than you can afford.
A Medicare Supplement plan can be a game-changer when it comes to paying for macular degeneration drugs. Supplement plans pick up where Medicare leaves off. Medicare Supplement plans help cover the out-of-pocket costs left behind by Medicare and can help you save on medical costs each year.
At MedicareFAQ, we help you find the most cost-effective coverage for your situation. Fill out our online rate comparison form or give us a call at the number above to get started.
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Does Medicare cover a follow visit for dry macular degeneration a year after the initial diagnosis
Hi Kathleen! If the exam is performed by your PCP, yes.
My mother’s doctor told her (I was there) that she had to start with Avastin injections before medicare would pay for Eyelea. Now there are some serious side effects. Was that a true statement? We didn’t know that there were known issues with the delivery system…
Hi Deborah! I’m sorry your mother is having some bad side effects from the injections. For certain treatments, Medicare does require that you try alternative treatments first. If they are unsuccessful in treating your condition, then Medicare will approve other treatment options that they may have declined the first time around.
will medicare pay for Photodynamic Therapy for my macular degeneration I also have aarp plan F supplement plan
Hi Carol! Yes, Medicare will cover Photodynamic therapy.
will Medicare cover injections in both eyes on the same day? I have received treatment in left eye for 5 years, but now that I have AMD in right eye, it will require injections in each eye once a month. If I have to have separate appointments, it means traveling to doctor’s office every other week. I would like to have injections done together, if possible. thanks for any info. –I have tried to find this on Medicare site, but have had no luck.
This is a great question! If your doctor says it’s medically necessary, then Medicare should cover both injections at the same time. However, I would ask your doctor to confirm. They should be able to tell by the CPT codes they use for your visit if Medicare will allow them to bill for both eye injections on the same day.