Wet AMD treatments can be costly, but Medicare covers some options. Knowing what Medicare covers and what it doesn’t can help you choose the best treatments for your budget.
Age-related macular degeneration (AMD) is an eye condition that occurs when the central part of the retina, called the macula, starts to break down with age. This causes vision loss.
AMD can occur in two ways: wet and dry. Both can interfere with daily activities and cause blurring or loss of central vision. If you have wet AMD, noticeable changes to your vision can happen rapidly.
Managing wet AMD often requires specialized treatments and frequent doctor visits, which can get expensive. However, if you have Medicare, it may cover some treatments.
Read on to learn which treatments are covered, which treatments aren’t covered, and what costs you may be responsible for paying.
Medicare covers several treatments for wet AMD under Medicare Part B. Part B is one part of Original Medicare and provides medical services you get outside the hospital.
These treatments can include medications that are injected directly into the eye to stop the growth of abnormal blood vessels and slow the disease. This may include:
- aflibercept (Eylea)
- ranibizumab (Lucentis)
- bevacizumab (Avastin)
- faricimab (Vabysmo)
Medicare typically helps pay for testing, medication, and doctor’s visits.
It may also include coverage for tests like optical coherence tomography (OCT) and fluorescein angiography. Doctors use these tests to monitor disease progression and assess treatment effectiveness.
In some cases, Medicare may cover laser treatments, like photodynamic therapy (PDT) with verteporfin (Visudyne), which targets and breaks down abnormal blood vessels.
Yet this method doesn’t work for all wet AMD cases. It mainly helps prevent vision from getting worse, with only a small chance of improving sight.
Costs can vary depending on the medication. For instance, bevacizumab is the least expensive option, costing $50 to $100 per treatment, while ranibizumab and aflibercept range from $1,800 to $2,000 per treatment.
The cost for faricimab in 2022 was about
Most people don’t pay these amounts in full. Medicare covers up to 80% of the approved cost for injectable treatments. This means you’ll pay 20% coinsurance after meeting your Part B deductible, which is about $257 in 2025.
But because treatments are often required every 4 to 6 weeks, the out-of-pocket costs can add up, even with Medicare paying part of it. To help with these expenses, you might consider a Medigap plan or a Medicare Advantage (Part C) plan.
Medigap is supplemental insurance that works with Original Medicare (parts A and B) to cover some or all of your out-of-pocket costs, like coinsurance and deductibles.
Medicare Advantage plans, on the other hand, are an alternative to Original Medicare that private insurers offer. These plans must provide the same level of coverage as Original Medicare but often also include additional benefits, like vision and hearing coverage.
Medicare Part B doesn’t cover everything related to wet AMD.
For example, Medicare typically doesn’t pay for alternative or complementary therapies like dietary supplements, acupuncture, or microcurrent stimulation, even if they’re used to support vision health.
It also doesn’t cover visual aids, such as glasses or low vision devices, which people with AMD often need to manage daily tasks.
Medicare also won’t cover experimental or investigational treatments unless they’re part of a qualifying clinical trial. A qualifying study is a clinical trial approved by Medicare.
Plus, Medicare doesn’t cover treatments provided by doctors who don’t accept Medicare or fail to follow its billing guidelines. Be sure to confirm that a doctor accepts Medicare before starting any treatment. This may help you avoid unexpected expenses.
If you have Medigap or a Medicare Advantage plan, know that coverage for certain treatments can change from year to year. It’s also important to review your policy annually to understand what’s included.
If you’re looking for resources to help navigate treatment options, a good starting point is the official Medicare website. There, you can research specific treatments, doctors, and out-of-pocket costs.
For personalized assistance, you can reach out to your local State Health Insurance Assistance Program (SHIP).
SHIP counselors offer free, one-on-one help to explain your Medicare benefits and whether extra coverage, like Medigap or Medicare Advantage, may be a good choice for you.
You can also speak directly with an ophthalmologist or retina specialist about treatment options.
These doctors can offer tailored advice and explain how Medicare can help cover costs. This can help ensure that your care plan is both effective and affordable.
When it comes to medication costs, manufacturers of commonly prescribed drugs often offer financial assistance programs.
Visit their websites to learn whether they provide patient support programs or copay assistance to help reduce your out-of-pocket expenses. These programs can be a key part of your financial plan if you find it difficult to afford treatment.
In addition, organizations like the PAN Foundation and RxAssist offer resources to help with medication costs. They provide information about patient assistance programs and may connect you with other forms of financial support.
Advocacy groups like the American Macular Degeneration Foundation (AMDF) and Prevent Blindness also offer patient education, support services, and updates on the latest treatment options.
Managing wet AMD is possible with the right treatments and support. Medicare Part B covers many options and resources like Medicare’s website and SHIP can help you understand coverage.
To help with costs, you can check whether your drug manufacturer offers assistance programs. Early intervention and working closely with your doctor are essential to protecting your vision.