Macular degeneration is a leading cause of vision loss in older adults, affecting millions of Americans. Many individuals rely on Medicare to cover medical expenses related to this condition. If you or a loved one has been diagnosed with macular degeneration, it is essential to understand what Medicare covers and any potential out-of-pocket costs.
Does Medicare Pay for Treatment for Macular Degeneration?
Yes, Medicare provides coverage for certain treatments related to macular degeneration. Specifically, Medicare Part B covers medically necessary services and treatments for age-related macular degeneration (AMD), including:
- Intravitreal Injections – Anti-VEGF (vascular endothelial growth factor) injections such as Lucentis, Eylea, and Avastin are commonly used to slow the progression of wet macular degeneration.
- Diagnostic Tests – Optical coherence tomography (OCT) scans and fluorescein angiography, used to detect AMD, are typically covered.
- Certain Medications – Some drugs administered in a doctor’s office for macular degeneration may be covered under Part B.
It is important to note that Medicare does not typically cover routine eye exams for vision correction, but it will cover medically necessary eye exams for those diagnosed with macular degeneration.
What Are the 6 Things Medicare Doesn’t Cover?
While Medicare provides substantial coverage for many healthcare needs, there are several services it does not cover, including:
- Routine Vision Exams – Regular eye exams for vision correction are not covered unless medically necessary.
- Prescription Glasses and Contact Lenses – Except for post-cataract surgery cases, Medicare does not cover eyewear.
- Long-Term Care – Nursing home or custodial care is not covered.
- Dental Care – Routine dental checkups, cleanings, dentures, and other dental services are not included.
- Hearing Aids and Exams – Medicare does not cover hearing aids or exams for fitting them.
- Cosmetic Procedures – Elective cosmetic surgeries are generally not covered.
What Benefits Can I Claim If I Have Macular Degeneration?
Individuals with macular degeneration may qualify for additional benefits beyond Medicare coverage, including:
- Low Vision Rehabilitation – Medicare may cover occupational therapy and rehabilitation services to help individuals adapt to vision loss.
- Supplemental Insurance (Medigap) – A Medigap policy can help cover out-of-pocket expenses such as copays and deductibles.
- Medicare Advantage (Part C) Plans – Some Medicare Advantage plans offer additional vision benefits beyond Original Medicare.
- State Assistance Programs – Some states provide additional aid for low-income individuals with vision impairment.
- Social Security Disability Benefits – If macular degeneration severely impacts daily living and work ability, Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) may be options.
How Much Does It Cost to Treat Macular Degeneration?
The cost of macular degeneration treatment varies depending on the severity of the condition and the type of treatment required. Some estimated costs include:
- Anti-VEGF Injections – Treatments like Eylea and Lucentis can cost between $1,500 to $2,000 per injection, with injections typically required every 4-8 weeks. Medicare Part B covers 80% of the cost after the deductible, leaving patients responsible for 20% unless they have supplemental insurance.
- Diagnostic Tests – OCT scans can cost between $100 and $300 per scan, with Medicare covering medically necessary scans.
- Rehabilitation Services – Vision therapy and rehabilitation services may have varying costs, but Medicare may cover a portion if deemed medically necessary.
Final Thoughts
Medicare provides significant coverage for macular degeneration treatments, particularly for medically necessary services like injections and diagnostic tests. However, beneficiaries should be aware of potential out-of-pocket costs and explore additional benefits through Medigap, Medicare Advantage, or state assistance programs.
If you or a loved one is affected by macular degeneration, it is essential to stay informed about available coverage options and speak with your healthcare provider about the best treatment plan.
For more details on Medicare coverage and additional benefits, contact MedicareABC today to speak with a professional consultant. Call us
