Does Medicare Cover Macular Degeneration? Costs and Coverage Limits

Medicare does cover macular degeneration. Under Part B, beneficiaries diagnosed with age-related macular degeneration (AMD) can get medically necessary eye exams, imaging, injectable drug therapies, and certain surgical treatments. Medicare generally pays 80 percent of the approved amount after you meet the annual Part B deductible, leaving you responsible for the remaining 20 percent plus any facility copay if the service happens in a hospital outpatient setting.¹

What Part B Covers for AMD

Medicare Part B covers “certain diagnostic tests and treatments (including treatment with certain injectable drugs)” when a doctor determines they are medically necessary to diagnose or manage AMD.¹

On the diagnostic side, that includes dilated eye exams, visual acuity tests, optical coherence tomography (OCT), fluorescein angiography, and Amsler grid testing.² A distinction matters here: Medicare covers eye exams ordered to evaluate or monitor a medical condition like AMD, but not routine vision exams done to prescribe glasses or contacts.¹

For wet (neovascular) AMD, the first-line treatment is anti-VEGF injections, administered in the doctor’s office. Part B covers them because they are physician-administered rather than taken at home. Covered drugs include bevacizumab (Avastin), ranibizumab (Lucentis), aflibercept (Eylea), faricimab (Vabysmo), brolucizumab (Beovu), and aflibercept HD (Eylea HD).³⁴

Older and less common treatments remain covered as well. Photodynamic therapy with verteporfin (Visudyne) is covered for wet AMD under a specific National Coverage Determination, though in practice anti-VEGF injections have largely replaced it.⁵⁶⁷

Dry AMD and Geographic Atrophy

For years there were no approved drug treatments for dry AMD. That changed in 2023 with the FDA approvals of two complement inhibitors for geographic atrophy, the advanced form of dry AMD:

Syfovre (pegcetacoplan), approved February 2023, given by intravitreal injection every 25 to 60 days, with a price of about $2,190 per dose.⁸
Izervay (avacincaptad pegol), approved August 2023, given every 21 days at roughly $2,100 per dose.⁸

Medicare Part B generally covers both when a physician documents medical necessity.⁹ Medicare Advantage plans cover them as well, often with prior authorization and clinical criteria such as a minimum lesion size and no active wet AMD.¹⁰ Both drugs carry safety considerations worth discussing with your retinal specialist. Clinical trials linked Syfovre to new-onset wet AMD in 7 to 12 percent of patients compared to 3 percent in controls, and post-launch reports of retinal vasculitis prompted an FDA labeling update in November 2023. Izervay showed a 7 percent rate of new wet AMD against 4 percent for controls, with no vasculitis reports.¹¹

What You’ll Pay

With Original Medicare, you first pay the annual Part B deductible, which is $283 for 2026.¹² After that, you owe 20 percent of the Medicare-approved amount for the drug and for the physician’s services. If treatment takes place in a hospital outpatient department, a separate facility copay applies.¹

The 20 percent coinsurance depends heavily on which drug your doctor uses. Medicare claims data show average per-injection payments of roughly $71 for bevacizumab, $334 for ranibizumab, and $922 for aflibercept.¹³ At the high end, 20 percent of a single Eylea injection that Medicare pays about $1,651 for comes to more than $300. Multiply that by six or more injections a year on a monthly schedule, and the math adds up fast. The coinsurance on a bevacizumab injection, by contrast, runs about $14.¹⁴ Clinical studies have found bevacizumab performs similarly to the costlier alternatives for many patients.²

Lowering Your Out-of-Pocket Costs

A Medigap (Medicare Supplement) policy can substantially reduce or eliminate your share of the bill. Plan G covers 100 percent of the Part B coinsurance and excess charges. Plan N covers the coinsurance with small office visit copays. Plans K and L pay 50 percent and 75 percent of the coinsurance respectively and include annual out-of-pocket caps.¹⁵

If you don’t have supplemental coverage, several independent foundations run copay assistance funds for macular degeneration, including the PAN Foundation, Good Days, the HealthWell Foundation, and the Patient Advocate Foundation’s Co-Pay Relief program. These funds open and close as donations allow.¹⁶ The Patient Advocate Foundation’s macular degeneration fund offers up to $4,500 per year when open.¹⁷ Drug manufacturer copay cards are generally restricted to commercially insured patients and not available to people on Medicare, but the Genentech Patient Foundation provides free medication to eligible uninsured or underinsured patients.¹⁸

Medicare Advantage: Extra Steps to Watch For

Medicare Advantage plans must cover everything Original Medicare covers for AMD, but they can add requirements that affect how quickly you get treated and which drug you receive. Since 2019, CMS has allowed Medicare Advantage plans to apply step therapy to physician-administered Part B drugs, and anti-VEGF injections are a frequent target. Original Medicare does not use step therapy.¹⁹

Step therapy typically means trying the cheaper drug (usually bevacizumab) before the plan will cover a costlier alternative. A 2024 study in JAMA Health Forum found that when one large insurer added step therapy, the rate at which new patients were prescribed bevacizumab rose from 61 percent to 70 percent.²⁰ A 2025 study found 47 percent of Medicare Advantage patients subject to step therapy were switched to a different anti-VEGF drug within the first year, compared with 31 percent in Original Medicare.¹⁹

Prior authorization also creates delays. A 2024 JAMA Ophthalmology study of more than 2,200 anti-VEGF prior authorization requests found that 96 percent were ultimately approved, but nearly 60 percent of approvals involved delays longer than 24 hours, and about 12 percent of delayed cases took more than 31 days to resolve. Clinic staff spent a median of 100 minutes per request on paperwork.²¹ If a Medicare Advantage plan denies or restricts your coverage, you have the right to appeal, and documentation from your treating ophthalmologist strengthens the request.²

What Medicare Does Not Cover

Several items that AMD patients commonly want fall outside Medicare coverage:

Routine eye exams for prescribing glasses or contacts.
Low-vision devices such as magnifiers, portable video readers, electronic enlargement devices, telescopic lenses, and white canes. These are excluded under a long-standing regulatory interpretation that treats them as falling within the Medicare statute’s eyeglass exemption.²²²³
Services from low-vision therapists, orientation and mobility specialists, and similar professionals remain largely uncovered, though Medicare pays for some vision rehabilitation.²⁴
AREDS2 supplements, the vitamin formulations often recommended to slow intermediate dry AMD, are over-the-counter and not covered as medical treatments.²

If any of these are important to your care, plan for them separately. Some Medicare Advantage plans bundle in routine vision benefits or allowances for glasses that Original Medicare won’t pay for, which is worth checking against the step-therapy and prior-authorization tradeoffs those plans may bring on the medical side.

1
Medicare.gov. Macular Degeneration Tests and Treatment
2
Solace Health. Medicare Macular Degeneration Treatment
3
Centers for Medicare & Medicaid Services. Billing and Coding Article A52451
4
Johns Hopkins Health Plans. Standard Medicare Part B Management Lucentis and Biosimilars
5
Centers for Medicare & Medicaid Services. NCA Decision Memo for Ocular Photodynamic Therapy
6
American Academy of Ophthalmology. LCD L33584 Implantable Miniature Telescope
7
CRST. Telescope Implant Moves Into the ASC
8
National Library of Medicine. Geographic Atrophy Treatments
9
Drugs.com. Syfovre Covered by Medicare
10
Louisiana Blue Cross Blue Shield. Pharmacotherapy for Geographic Atrophy Policy No 087
11
Excellus BCBS. Geographic Atrophy Policy
12
MedicareAdvantage.com. Does Medicare Cover Macular Degeneration
13
National Library of Medicine. Anti-VEGF Drugs for Age-Related Macular Degeneration
14
Institute for Advancing Clinical Treatments. Part B AMD Drugs White Paper
15
Longwood Eye & LASIK Center. Medicare Open Enrollment What Retina Patients Should Know About Drug Costs
16
American Society of Retina Specialists. Patient Assistance Resources
17
Patient Advocate Foundation. Macular Degeneration Fund
18
Genentech. Vabysmo Access Resources
19
Managed Healthcare Executive. Step Therapy Associated With More Switching of Anti-VEGF Treatment
20
JAMA Health Forum. Step Therapy and Anti-VEGF Prescribing for Macular Degeneration
21
National Library of Medicine. Anti-VEGF Pharmaceutical Prior Authorization in Retina Practices
22
ITEM Coalition. Position Statement on Medicare Patient Access to Low Vision Assistive Technology
23
American Macular Degeneration Foundation. Low Vision Rehabilitation
24
NCOA. Medicare Should Cover Vision Services and Assistive Devices