Does Medicare cover Cataract Surgery? – Overview
Cataracts are incredibly common eye problems in seniors. According to reports, over half of Americans over 80 years old have cataracts or have undergone eye surgery to treat cataracts. Cataracts develop a cloudy patch in the lens of your eyes. This can cause blurred vision, sensitivity to light, faded colors and double vision. If you don’t have health insurance cover, then cataract surgery can cost you anywhere between US$ 3,780 to US$ 6,890 and over. While Original Medicare does not cover eyes treatments such as the cost of ophthalmologic visits, contact lenses and glasses, it does cover the cost of undergoing cataract surgery with certain criteria.
Medicare covers cataract eye surgery which is performed using conventional techniques or using the laser.
How Much Does Cataract Surgery Cost?
There are two major kinds of cataract surgeries. Medicare offers coverage of cost for both types of cataract eye surgeries, which includes:
- Extracapsular – This type of cataract surgery removes the clouded lens in one piece and an intraocular lens (IOL) is inserted to replace the damaged lens.
- Phacoemulsification – This type of cataract surgery uses ultrasound techniques to disintegrate the clouded eye lens before removing it and replacing it with an IOL device.
The eye doctor prescribes the specific type of cataract surgery, depending on your individual diagnostic. For those without insurance, the minimal cost of cataract surgery is at least US$ 3,700 and the cost can vary greatly from state to state and the patient’s specific requirement.
However, if you have Medicare, then the exact cost of your cataract surgery will be determined by:
- Your specific Medicare plan
- The type of eye surgery you require
- The time duration it takes to perform the eye surgery
- The place you are undergoing eye surgery to remove cataracts (like hospital or clinic)
- Prevalent or existing medical conditions you may have
- Potential post-surgical complications
Normally, the cost of cataract eye surgery with Medicare is as follows:
- Cataract surgery performed in an eye clinic or surgery center will cost a total of US$ 977, of which Medicare pays around US$ 781 while you will have to pay around US$ 195 out of your pocket.
- Cataract surgery performed at a hospital (in the outpatient department) normally costs around US$ 1,917, of which Medicare pays up to US$ 1,533 while the remainder US$ 383, needs to be borne by the patient.
These estimates exclude physician fees and other procedure-related charges. These are national averages and the figures may vary from state to state.
Does Medicare Cover Cataract Surgery?
Medicare offers to cover the cost of basic cataract surgery, such as:
- Lens implantation
- Cataract removal
- Single pair prescription eyeglasses OR set of contact lenses post-surgery
Let’s take a detailed look at the type of Medicare plans and how they cover the cost of cataract surgery:
Medicare Part A
Medicare Part A covers the cost of inpatient and hospital. In the majority of instances, hospital visits are not required for cataract surgery. However, if you do need to be admitted to a hospital for cataract removal eye surgery then Medicare Part A will cover its costs.
Medicare Part B
Those who have a Medicare Part B plan can expect their insurance to cover the cost or outpatient procedures and other related medical expenses. For individuals with Original Medicare insurance plans, the cost of cataract surgery will be covered under Medicare Part B. This insurance coverage also pays for doctor’s appointments, such as pre and post-surgical visits.
Medicare Part C
Individuals with Medicare Part C (Advantage Plans) are offered the same benefits for eye surgery as under Medicare Part A and Medicare Part B insurance policies. The specific type of Medicare Advantage Plan you choose will determine whether the insurance policy will cover all or part of the cataract eye surgery cost.
Medicare Part D
Medicare Part D covers the cost of certain prescription medicines. In case you require prescription medication after undergoing cataract eye surgery, then it is covered under Medicare Part D. However, you need to ensure that the prescribed medication is on the Medicare Part D eligible list, else you would end up paying for the medication out of your pocket.
Medigap (Medicare Supplement Plan)
If you have a Medigap plan, then you can expect your insurance policy to cover some costs that the Original Medicare plans fail to cover. Those with Medigap insurance plans are advised to contact their healthcare provider and determine the specific expenses that are covered under it. There are some Medigap plans which cover co-pays and deductibles for individuals with Medicare Part A and Medicare Part B.
Cataract surgery is covered under Medicare. However, Medicare will not bear the complete expenses of cataract eye surgery and you may end up having to co-pay the remaining amount out of your pocket. The same stands for those with Medigap as the Advantage Plans also offer partial payment for the total cost of cataract surgery. Be prepared to pay deductibles, co-insurance, co-payments and premium fees if you are covered by Medicare and plan to undergo a cataract eye surgery. It is strongly advised to consult your eye doctor/physician and learn the specific costs that will be covered under your Medicare health insurance plan.