Medicare Coverage for Macular Degeneration: 2025 Guide
Age-related macular degeneration (AMD) is the leading cause of vision loss in Americans over 50 and affects more than 11 million people in the U.S. The good news: Medicare Part B covers the anti-VEGF injections that have transformed wet AMD from a disease that reliably caused blindness into one that can be effectively managed — but the 20% coinsurance can add up quickly without Medigap coverage.
Macular Degeneration Coverage Quick Reference
| Service | Part | Your Cost (2025) | Notes |
|---|---|---|---|
| Comprehensive eye exam (medical) | Part B | 20% after $257 deductible | For AMD diagnosis and monitoring; routine eye exams NOT covered |
| Optical coherence tomography (OCT) | Part B | 20% after deductible | Essential retinal imaging for AMD monitoring |
| Fluorescein angiography | Part B | 20% after deductible | Dye-based imaging to assess wet AMD activity |
| Bevacizumab (Avastin) injection — intravitreal | Part B | 20% after deductible | Off-label but widely used; lowest cost ~$50–$70/dose; physician-administered |
| Ranibizumab (Lucentis) injection | Part B | 20% after deductible | FDA-approved for AMD; ~$1,200/dose Medicare-approved amount |
| Aflibercept (Eylea) injection | Part B | 20% after deductible | FDA-approved; ~$1,800/dose; widely used for wet AMD |
| Aflibercept 8mg (Eylea HD) injection | Part B | 20% after deductible | Higher dose; allows less frequent injections (every 12–16 weeks) |
| Faricimab (Vabysmo) injection | Part B | 20% after deductible | Dual-mechanism (anti-VEGF + anti-Ang-2); up to every 16 weeks |
| Brolucizumab (Beovu) injection | Part B | 20% after deductible | Every 12 weeks for some patients |
| Port delivery system (Susvimo) | Part B | 20% after deductible | Implanted reservoir delivering ranibizumab; refilled every ~6 months |
| Photodynamic therapy (verteporfin/Visudyne) | Part B | 20% after deductible | Less commonly used since anti-VEGF era; still covered |
| Low vision examination | Part B | 20% after deductible | For vision rehabilitation planning |
| Low vision rehabilitation | Part B | 20% after deductible | Training with magnifiers, lighting, adaptive techniques |
| Vitamins (AREDS2 formula) | Not covered | 100% out of pocket | OTC supplements; not covered despite strong evidence for intermediate AMD |
| Routine eye exam / glasses / contact lenses | Not covered | 100% out of pocket | Standard eyeglasses and routine eye care not covered under Original Medicare |
The Anti-VEGF Injection Landscape
Anti-VEGF (anti-vascular endothelial growth factor) injections delivered directly into the eye (intravitreal injections) are the standard of care for wet (neovascular) AMD. They work by blocking the abnormal blood vessel growth that causes wet AMD vision loss. Medicare Part B covers all FDA-approved options plus off-label bevacizumab:
Bevacizumab (Avastin) — Off-Label but Widely Covered
Originally approved as a cancer drug, bevacizumab is widely used off-label for wet AMD at a fraction of the cost of approved alternatives ($50–$70/dose vs. $1,200–$2,500). Medicare Part B covers it when compounded and physician-administered. Clinical trials (CATT, IVAN) found it equivalent in efficacy to ranibizumab. This is why many retinal specialists offer it as a first-line option.
Newer Agents Requiring Less Frequent Injections
A major advance in recent years is the development of agents that maintain efficacy with less frequent dosing — reducing patient burden and injection-associated risks:
- Faricimab (Vabysmo): Dual mechanism; many patients reach 12–16 week dosing intervals
- Aflibercept 8mg (Eylea HD): Higher concentration allowing 12–16 week intervals after loading doses
- Port Delivery System (Susvimo): Implanted reservoir that continuously releases ranibizumab; refilled every ~6 months via office procedure
All are covered under Part B at 20% coinsurance. Medigap Plan G covers that 20%.
Dry AMD: What Medicare Covers
Dry AMD (non-neovascular) affects about 90% of AMD patients. Until recently, there was no treatment to slow progression. In 2023, two complement inhibitors received FDA approval for geographic atrophy (advanced dry AMD):
- Pegcetacoplan (Syfovre): Monthly or every-other-month intravitreal injection; covered under Part B
- Avacincaptad pegol (Izervay): Monthly intravitreal injection; covered under Part B
These are expensive new drugs (estimated $2,000–$2,500/injection). Without Medigap, 20% coinsurance on monthly injections can exceed $5,000/year. Medigap Plan G makes these injections effectively free after the Part B deductible.
For intermediate dry AMD, AREDS2 vitamin supplements (containing lutein, zeaxanthin, vitamin C, vitamin E, and zinc) are recommended by the NEI — but are NOT covered by Medicare. They are available OTC for approximately $20–$30/month.
The Routine Eye Exam Coverage Gap
Medicare does NOT cover routine eye exams, eyeglasses, or contact lenses under Original Medicare. This is a significant coverage gap for older adults. However:
- Eye exams for a medical condition (AMD, diabetic retinopathy, glaucoma) ARE covered under Part B at 20%
- Glaucoma screening is covered annually for high-risk patients (diabetics, family history, African Americans over 50, and others)
- After cataract surgery, one pair of eyeglasses or contact lenses is covered under Part B
- Many Medicare Advantage plans include routine vision benefits — this is one area where MA plans offer a meaningful advantage
Low Vision Rehabilitation
For AMD patients who have lost significant central vision, Medicare covers low vision rehabilitation services:
- Low vision examination to assess remaining functional vision
- Training in use of optical aids (magnifiers, telescopes)
- Training in eccentric viewing techniques (using peripheral vision)
- Lighting optimization strategies
- Training in assistive technology (screen magnifiers, voice assistants)
These services are covered under Part B at 20% coinsurance when provided as part of a medically necessary treatment plan.
Frequently Asked Questions
Yes. Medicare Part B covers intravitreal anti-VEGF injections for wet age-related macular degeneration, including bevacizumab (Avastin), ranibizumab (Lucentis), aflibercept (Eylea and Eylea HD), faricimab (Vabysmo), and brolucizumab (Beovu). You pay 20% of the Medicare-approved amount. For injections costing $1,500–$2,500 each, your 20% share is $300–$500 per injection — and many patients receive injections every 4–8 weeks. Medigap Plan G covers that 20% entirely, making injections essentially free after the $257 annual Part B deductible.
Medicare covers eye exams for medical conditions — including macular degeneration, diabetic retinopathy, and glaucoma — under Part B at 20% coinsurance. Routine eye exams for glasses prescriptions are NOT covered under Original Medicare. Glaucoma screening is covered annually for high-risk patients at no cost. After cataract surgery, one pair of glasses or contact lenses is covered. Many Medicare Advantage plans include routine vision benefits that Original Medicare lacks.
No. The AREDS2 vitamin formula (lutein, zeaxanthin, vitamin C, vitamin E, zinc) is strongly recommended by eye doctors for patients with intermediate AMD to reduce progression risk — but over-the-counter supplements are not covered by any part of Medicare. You pay 100% out of pocket, typically $20–$30/month. Despite the strong clinical evidence for AREDS2 supplements, Medicare does not cover OTC vitamins regardless of medical indication.