Does Medicare Cover Cataract Surgery – Overview
Cataracts are incredibly common eye problems in seniors. According to reports, over half of Americans over 80 have cataracts or have undergone eye surgery to treat them.
Cataracts develop a cloudy patch in the lens of your eyes. This can cause blurred vision, sensitivity to light, faded colors, and double vision.
Cataract surgery can cost between $3,000 and $5,000 if you don’t have health insurance coverage.
Original Medicare does not cover eye exams for prescribing or fitting eyeglasses or contact lenses. Still, it covers cataract surgery if it is medically necessary, including one pair of eyeglasses or contact lenses after surgery.
Medicare covers cataract eye surgery performed using conventional techniques or a laser.
How Much Does Cataract Surgery Cost with Medicare
There are two major kinds of cataract surgeries. Medicare offers coverage of cost for both types of cataract eye surgeries, which include:
Extracapsular – This type of cataract surgery removes the clouded lens in one piece and an intraocular lens (IOL) is inserted to replace the damaged lens.
Phacoemulsification – This type of cataract surgery uses ultrasound techniques to disintegrate the clouded eye lens before removing it and replacing it with an IOL device.
The eye doctor prescribes the specific type of cataract surgery, depending on your individual diagnosis.
For those without insurance, the minimal cost of cataract surgery is at least US$ 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 the following:
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 a hospital or clinic)
Prevalent or existing medical conditions you may have
Potential post-surgical complications
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 inpatient hospital stays. Most cataract surgeries are outpatient and are covered under Medicare Part B. However, if you need to be admitted to a hospital for cataract removal eye surgery, Medicare Part A will cover the costs.
Medicare Part B
Those with a Medicare Part B plan can expect their insurance to cover the cost of 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.
Your specific type of Medicare Advantage Plan will determine whether the insurance policy covers all or part of the cost of cataract eye surgery.
Medicare Part D
Medicare Part D covers the cost of certain prescription medicines, which may include medications required after cataract surgery if they are on the Medicare Part D formulary.
However, you need to ensure that the prescribed medication is on the Medicare Part D eligible list, or else you will have to pay for it out of your own pocket.
Medigap (Medicare Supplement Plan)
If you have a Medigap plan, it can help cover out-of-pocket costs like copayments, coinsurance, and deductibles not covered by Original Medicare.
Those with Medigap insurance plans are advised to contact their healthcare provider and determine the specific expenses that are covered under it.
Some Medigap plans cover co-pays and deductibles for individuals with Medicare Part A and Medicare Part B.
FAQs
What is the average cost of Cataract surgery?
In the US, cataract surgery may cost around $3,000 to $6,000 for each eye. It may vary depending on your location, health condition, type of surgery, hospital, and doctor's experience.
Medicare and different private insurance companies offer coverage for cataract surgery. Medicare and most private insurance typically cover the basic costs of the operation, the intraocular lens, and the surgeon's fees for medically necessary cataract surgery.
What types of financial programs are available for Cataract Surgery?
Several federal and private financial programs, including Medicare, are available for cataract surgery for low-income families.
People with cataracts or any other vision-related difficulties can get direct financial assistance through several programs run by non-profit organizations.
Is there a danger associated with cataract surgery?
Like any surgical procedure, cataract surgery also has specific potential consequences or risk factors.
Conditions such as eye infections, bleeding, swelling, and retinal detachment are possible complications of cataract surgery.
Conclusion
Cataract surgery is covered under Medicare. However, Medicare will not bear the complete expenses of cataract eye surgery and you may have 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.
If Medicare covers you and you plan to undergo cataract eye surgery, be prepared to pay deductibles, co-insurance, co-payments, and premium fees.
It is strongly advised to consult your eye doctor/physician and learn the specific costs covered under your Medicare health insurance plan.
See Also
Home Repair Grants for Senior Citizens
What is the cost of laser eye surgery
Does Medicaid Cover Weight Loss Surgery
Does Medicare Cover Hearing Aids
Follow us