Does Medicare Cover Macular Degeneration Treatments?

If you’re wondering if Medicare covers macular degeneration treatments, this article will outline Medicare’s role in managing this eye condition, including coverage of tests, medications, and procedures.

While delving into specifics about potential out-of-pocket costs and additional plans, this guide will ensure you get the facts needed to navigate your healthcare options.

Key Takeaways

• Medicare will likely provide coverage for treatments of macular degeneration, including 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.

• Some of the Medicare Advantage plans may 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 might vary by plan.

• Some of the potential out-of-pocket expenses for macular degeneration treatment could be mitigated through Medicare Supplement plans, which could help reduce the costs not covered by Medicare, and there may be various organizations and alternative treatments that could also support the management of the condition.

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 could significantly affect central vision, making it difficult for individuals to read and recognize faces, among other things. It could be attributed to age-related changes or genetics, and symptoms may include blurry central vision and difficulty distinguishing colors. Diagnosing and monitoring the condition will likely require regular macular degeneration tests.

Medicare’s Role in Macular Degeneration Treatment

Medicare will likely play a pivotal role in covering a variety of treatments for macular degeneration, including:

• Drugs

• Laser therapy

• Photodynamic therapy

• Surgery

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

Medicare Part B Coverage for Macular Degeneration

Medicare Part B will likely offer 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 may be responsible for covering up to 20% of the diagnostic exam cost. Medicare will likely cover the remaining 80%, known as the Medicare pay portion. In an outpatient setting, individuals may also have to make at least 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 could provide coverage for all original Medicare services, and some plans may even offer additional benefits like:

• Prescription drugs

• Vision

• Hearing

• Dental

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

The deductible and copays for macular degeneration screening with Medicare Advantage plans will likely depend on the specific plan you have.

Specific Treatments Covered by Medicare

Part B Medicare coverage may include eye injections for age-related macular degeneration and diabetic retinopathy, such as anti-VEGF injections for these conditions. Some of these injections could be 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 may provide coverage for various medications used for anti-VEGF injections, such as Eylea, Lucentis, and Beovu.

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

Beovu could serve 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 could help reduce annual medical costs including those that may be associated with treatments for macular degeneration, could be beneficial in alleviating some of the out-of-pocket expenses not covered by Medicare.

The potential cost of a Medicare Supplement plan for macular degeneration treatments may vary based on the chosen plan and the level of coverage it could offer.

Some of the most cost-effective Medicare Supplement plans for macular degeneration treatments can be found using tools like this website or by consulting with a licensed broker.

By entering your zip code into any of the zip code boxes on this website, you can:

• Compare different Medicare Advantage and Prescription Drug Plans

• Focus on drug coverage and costs to find the perfect fit for your healthcare needs

• Input your information and sort through a variety of plans

• Weigh the pros and cons of each based on your situation