Does Medicare Cover Macular Degeneration?
This article was updated on: 09/10/2018
If you are a Medicare beneficiary and have been diagnosed with macular degeneration, you will be relieved to know that Medicare may cover certain diagnostic tests and treatments for age-related macular degeneration. The drugs and services Medicare may cover depend on the type of macular degeneration you have and the treatment your health-care professional recommends for your condition.
What is macular degeneration?
Macular degeneration is characterized by a deterioration of the central portion of the retina, the nerve center of the eye responsible for detecting light. It is the leading cause of vision loss for people over 60, according to the National Institutes of Health. The Centers for Disease Control and Prevention states that 1.8 million Americans age 40 and older are affected by age-related macular degeneration, or AMD. Although AMD doesn’t result in complete blindness, people who suffer from macular degeneration gradually lose their central vision, limiting their ability to read, drive, and even manage activities of daily life.
There are two forms of macular degeneration, wet and dry. There is currently no cure for the dry form, which comes on gradually as a person ages; it frequently progresses to the wet form of macular degeneration, which is characterized by the formation of abnormal blood vessels in the eye which can leak into the retina, causing blurry vision and blind spots.
How is macular degeneration treated?
Macular degeneration is diagnosed by an eye test. While Medicare doesn’t cover routine vision exams, beneficiaries may be covered for certain preventive and diagnostic exams to treat eye conditions. If you think you may have macular degeneration, check with your doctor. Medicare may cover an exam to diagnose macular degeneration. Certain beneficiaries with Medicare Part B who have age-related macular degeneration may be covered.
While there is no cure for macular degeneration, there are treatments that can slow its progression and, in some cases, actually reverse some of the damage. These include injections into the eye itself to destroy abnormal blood vessels, dynamic phototherapy, and laser surgery. Some health-care providers also recommend nutritional supplements such as vitamin C and zinc.
Understanding Medicare coverage of macular degeneration
There is very limited Medicare coverage for vision services under Original Medicare, Part A and B. However, if you are diagnosed with age-related macular degeneration, Medicare Part B may cover certain treatments recommended by your physician, such as drug injections. Always double check first if a particular service or treatment ordered by your doctor is covered. If you’re enrolled in Medicare Part B, you’ll pay 20% of the Medicare-approved amount for prescription medications and doctor services (including office visits) you get as an outpatient, after you have met the deductible. If you receive these services in a hospital outpatient setting, you may also owe a copayment.
Medicare Part A covers macular degeneration if your condition causes a medical problem requiring hospitalization.
If you have a Medicare Advantage plan, your plan may have more coverage for routine eye and vision-related care and services. These plans usually include prescription drug benefits, which may pay for eye drops or other medications prescribed by your health-care provider to treat the symptoms of macular degeneration. Benefits may vary by plan, so check with the specific plan if you’re interested in routine vision coverage or prescription drug benefits.
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To learn more about macular degeneration, see:
National Institutes of Health, U.S. National Library of Medicine, “Macular Degeneration,” last updated July 7, 2016.
Centers for Disease Control and Prevention, “Vision Health Initiative (VHI) National Data,” last updated September 30, 2015.
This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.