What is the Coverage for Macular Degeneration in Health Insurance?

Health Insurance for AMD: Coverage, Medications & Therapies

Macular degeneration, or age-related macular degeneration (AMD), develops when the macula of the retina is damaged, causing the loss of central vision. People over 50 years of age, with a family history of AMD, hypertension, and being overweight, are prone to develop this disease.

AMD may not be curable, but it is treatable. Treatment generally consists of nutritional supplements and medications, which are expensive. However, health insurance coverage for macular degeneration helps patients handle the rising cost of medical treatment.

Let’s examine how health insurance policies in India approach this condition and how you can choose a policy that is suitable for your needs.
 

Does Health Insurance Cover Macular Degeneration?

The good news is that most health insurance plans cover treatment for macular degeneration. However, when opting for a plan, one should carefully review it, as coverage can vary across plans.

Apart from reviewing their plans closely, policyholders should definitely consider consulting an insurance agent or healthcare professional. This would help them better understand the nuances of a health policy and make an informed decision.

What to Look for in Health Insurance that Covers Macular Degeneration?

It’s important to know the factors that are essential for a good health insurance policy to treat age-related macular degeneration, such as:

1. Coverage for Diagnosis and Tests: As AMD stays mostly undetectable in its early stages, coverage for annual eye examinations is beneficial. Diagnosing the condition early can make treatment more effective. One should ensure that their health insurance coverage includes tests like the Amsler grid test, dilated eye exam, OCT, OCTA, fluorescein angiography, etc.
2. Nutritional Supplements Coverage: According to the Age-Related Eye Disease Studies (AREDS and AREDS2), a combination of vitamins and minerals, including vitamins C and E, copper, lutein, zeaxanthin, and zinc, can slow down the progression of dry AMD. It's crucial to verify if a health plan offers coverage for necessary nutritional supplements.
3. Coverage for Medications: Medications used to treat AMD include anti-vascular endothelial growth factor (anti-VEGF) injections. These injections block the development of a protein (VEGF) and stop the generation of new blood vessels. These drugs, which include Aflibercept, Ranibizumab, Bevacizumab, Faricimab-svoa, and Brolucizumab, can improve one's vision. Policyholders should ensure their plan covers such medication.
4. Access to Therapies: Apart from medications, treatments include photodynamic therapy (PDT) and laser photocoagulation. In PDT, a combination of a laser and an injectable light-sensitive drug is used to remove the extra blood vessels from the patient's eye.
   Laser photocoagulation involves using a laser to plug and remove the leaking blood vessels. A health plan should have provisions for such therapies.
5. Policy Inclusions and Exclusions: One of the best practices is to review a policy's inclusions and exclusions. By considering both what is covered and what is not covered, a policyholder can have a clear idea of what they are getting from the insurer when treatment is needed. Therefore, however comprehensive the plan is, reviewing inclusions and exclusions is essential.
6. Network Hospitals: Health insurance providers generally offer policyholders the benefit of cashless treatment at empanelled hospitals. If a provider has a large network of empanelled hospitals, one can avail of treatment from a facility of one's choice without any upfront payment. Considering plans that have a substantial network of hospitals can be beneficial.
7. Claim Process: However, if a policyholder decides to receive the treatments from a non-network hospital, they will need to claim reimbursement. Therefore, ensuring the service provider has a seamless claim process is essential. This allows the policyholder to have peace of mind during treatment and recovery from AMD.
    

If you or your family have macular degeneration, it’s crucial to opt for a health insurance plan. A suitable policy helps ease the financial burden during tough times, so it’s always wise to be prepared.

At Star Health, we also offer coverage for ophthalmic treatments, including macular degeneration, under our Star Comprehensive Insurance Policy. This plan covers diagnosis and treatment for various eye-related ailments, along with a wide network of hospitals and hassle-free claim settlement in a shorter turnaround time.

Also Read:

→ What is the Coverage for Learning Disabilities in Health Insurance

→ What is the coverage for eating disorders in health Insurance

→ What is Health Insurance for Huntington's Disease

→ What is Health Insurance For Schizophrenia Treatments

→ What Happens When You Miss an EMI for Health Insurance