April 11th 2024
By Ari Parker
Learn how Medicare covers treatment for macular degeneration. Find out what services are included and how to navigate your coverage options effectively.
Eye conditions are a common challenge for older adults. As we age, we experience a natural decline in our eyesight. Macular degeneration, a common eye condition, is one of the leading causes of vision loss in seniors.
Medicare may help cover screenings and treatment for macular degeneration, including injectable drugs. In this article, you’ll learn the costs for coverage and what to expect if you have macular degeneration.
Doctors most commonly prescribe injectable drugs to treat macular degeneration.
Medicare doesn’t usually provide coverage for vision care, but Part B may cover certain exams and treatment options if you have macular degeneration.
Also known as age-related macular degeneration (AMD), macular degeneration is an eye disease that affects the macula in your eye. The macula is responsible for central vision and helps you read, drive, recognize faces, and see fine details.
There are two types of macular degeneration: dry and wet AMD.
Dry macular degeneration occurs when your macular tissue gradually breaks down over time. This leads to small, yellow deposits called drusen forming under the retina, which can cause blurred or distorted central vision. Dry AMD is the most common type of macular degeneration.
Wet macular degeneration occurs when abnormal blood vessels form underneath the retina and leak fluid and blood. This causes the macula to deteriorate more rapidly, and you can experience a more sudden and severe loss of central vision. Wet AMD is less common than dry AMD, but the vision impairments can be more serious and progress more quickly.
While doctors don’t know the exact cause of macular degeneration other than aging, there are factors that can increase your risk of developing the condition, like:
Family history
Smoking
Obesity
Cardiovascular disease
There is no complete cure for AMD, but certain injectable drugs and photodynamic therapy can manage your remaining eyesight and help slow down the progression of macular degeneration.
If you think you have macular degeneration, your doctor will give you a thorough eye exam to assess the health of your macula and vision. Depending on your symptoms, you may undergo:
Vision acuity test: a basic vision test to check how well you can see using an eye chart
Dilated eye exam: examination of the macula and retina using eye drops to dilate the pupils and special instruments to look for signs of AMD
Amsler grid test: a simple test that involves looking at a grid of straight lines to check for abnormalities in central vision
Fluorescein angiography: used specifically for wet AMD, a special dye is injected into a vein in the arm and the dye circulates through the blood vessels in the retina, helping to identify any abnormal blood vessels or leakage
Optical coherence tomography (OCT): a non-invasive imaging test that uses light waves to produce images of the retina to check for signs of macular degeneration
Doctors most commonly treat macular degeneration with injectable drugs, though your specific treatment plan will depend on the type and stage of the condition. Here are some common injections:
Anti-VEGF injection: This treatment is more commonly prescribed for wet AMD. Certain medications are injected into the eye to block the growth of abnormal blood vessels and reduce leakage to slow the progression of macular degeneration.
Photodynamic therapy (PDT): PDT involves injecting a light-sensitive medication into the bloodstream. A doctor would then activate the drug by shining a special laser light into the eye to get rid of abnormal blood vessels.
Intraocular steroid injections: Doctors may prescribe steroid injectables to reduce inflammation and swelling, especially if a person doesn’t respond well to anti-VEGF treatment. However, steroid injections can increase the risk of cataracts and elevated eye pressure.
While Medicare doesn’t typically cover vision-related care, Medicare may cover screenings and treatment for macular degeneration depending on your situation. Confirm that Medicare will pay for screenings and treatment with your doctor before receiving care.
After you meet your Part B deductible, Medicare pays for 80% of the cost of the service, leaving you with the remaining 20%. A Medicare Supplement plan can help cover some of this coinsurance. If you choose to receive care at your local hospital’s outpatient department, you’ll have to pay a separate facility fee as well.
Medicare Advantage plans don’t have standardized out-of-pocket costs, so your copay, coinsurance, and deductible will vary, depending on your policy. Check your summary of benefits to understand your costs for macular degeneration treatment.
In some cases, doctors may recommend low vision aids such as magnifiers, telescopic lenses, and electronic devices to help maximize vision. However, it’s unlikely that Original Medicare or Medicare Supplement plans will cover any devices for vision. Certain Medicare Advantage plans may cover vision-related aids. Check your summary of benefits or get in touch with your insurance carrier for a clear answer.
There’s no doubt that healthcare is complex, and it’s not always easy to anticipate certain costs. If you need help understanding your coverage options for macular degeneration, a licensed Medicare Advisor at Chapter would be happy to help. Give us a call at 855-900-2427 or schedule a time to chat for a free consultation tailored to your needs.
