Medicare covers traditional cataract surgeries. These policies also include a traditional intraocular lens implant and the first pair of spectacles following surgery.
Medicare pays the same amount toward cataract surgery whether a surgeon conducts it with or without a laser. However, laser surgery has a higher cost and is used for those who have astigmatism and need a premium lens implant. The surgical center will ask the enrollee to pay the difference between the covered amount and the additional costs of laser surgery.
They also do not cover the cost of newer multifocal lenses.
According to the National Eye Institute, around 50% of adults have a cataract or have undergone cataract surgery by the time they reach 80 years of age.
For adults aged 65 years and older, the requirements for cataract surgery coverage vary between regions and local Medicare carriers. However, generally, a doctor must deem cataract surgery to be medically necessary, and the treating physician must accept a Medicare plan as payment.
Typically, Medicare pays 80% of the expenses related to surgery and does not cover 20% of the costs. Medicare also pays for one pair of glasses after cataract surgery.
This article explains the costs of cataract surgery and which expenses Medicare will and will not cover. It also looks at cataract surgery, what is involved, and when it is necessary.
Usually, Medicare pays 80% of the total surgical cost, consisting of surgical and facility charges, as long as a doctor has deemed it medically necessary.
The plan covers the following services:
- preoperative exams
- removal of the cataract
- implantation of the lens
- postoperative exams
- one pair of prescription eyeglasses after the surgery
Medicare Part A covers inpatient hospital stays. People do not usually require an overnight stay after cataract surgery. However, if a hospital stay is necessary due to significant complications, Part A will cover the extra accommodation costs.
Medicare Part B covers medically necessary procedures, including cataract surgery. It also covers certain postsurgical costs.
Usually, Medicare does not cover prescription eyeglasses. The exception is one pair of spectacles after cataract surgery.
Since various factors can affect the cost, people should check their annual deductible for Medicare Part B.
Medicare does not cover the remaining 20% of the cost of the cataract surgery. Plans may also exclude certain other charges, including deductibles and medications such as eye drops.
The surgeon inserts a type of lens called an intraocular lens (IOL). However, Medicare may not cover all types of IOL. It does pay for monofocal lenses, which a surgeon will typically use during cataract surgery.
Although other lenses are available, including multifocal and toric lenses, Medicare may not cover these. They will also not pay for procedures exclusive to the implantation of these more advanced lenses that a surgeon would not perform for a traditional monofocal lens.
Lifestyle factors and daily activities will define the best type of lens for a person receiving cataract surgery. They will need to discuss this with their eye surgeon and remain aware of the extra costs associated with more advanced lenses.
To work out potential out-of-pocket costs, a person should ask their doctor the following questions ahead of surgery:
- Does the doctor accept Medicare?
- Will the surgery take place in a hospital or at a surgical center?
- Will the procedure take place on an inpatient or outpatient basis?
- Which medications are the doctor likely to prescribe ahead of and following surgery?
It is also good practice to ask for the Medicare code for the procedure, as this will help you more accurately define coverage through this online tool, provided by Medicare.
Some researchers have found prices in the range of almost $2,700 for one eye and slightly over $5,200 for two eyes.
However, the cost of cataract surgery can vary across state lines and based on individual needs. For example, it may cost more depending on the type of procedure and whether the surgery takes place in an outpatient surgical center or a hospital.
Individual surgeon fees also vary, which may affect the total cost of the procedure. The type of lens implant also changes the price.
It is best to discuss the overall charges with the surgeon for the most accurate picture of the eventual cost.
However, Medicare will pay for 80% of the procedure fee regardless of the cost.
Medicare supplemental plans, also known as Medigap, are private insurance policies that help people pay the 20% of costs excluded from Medicare coverage.
For instance, supplemental plans may pay deductibles, copayments, and other out-of-pocket expenses. Any person aged 65 years or older with Medicare parts A and B can apply for a supplemental plan.
The costs of Medicare supplemental plans vary.
Cataracts involve a clouding of the lens in the eye.
According to the American Academy of Ophthalmology, aging is the most common cause of cataracts. Normal proteins in the lens start to break down as a person becomes older. Over time, this breakdown causes cloudiness in the lens, which can interfere with vision.
Cataract surgery involves removing the cloudy lens through an incision and implanting an IOL.
There are two main types of cataract surgery: phacoemulsification and extracapsular surgery.
Medicare covers both types of procedure.
Both surgeries involve implanting an IOL. An eye surgeon will help the person decide which type of surgery may be best for their needs.
This is the most common type of cataract surgery. The procedure involves making a small cut in the cornea and inserting an ultrasound probe through the incision.
The probe breaks the clouded lens into tiny pieces that the surgeon then removes from the eye using a suction device.
In this procedure, the surgeon removes the cloudy lens in one piece through an incision. They leave a pouch into which they can insert an IOL.
Cataracts do not often produce symptoms in the early stages. In fact, at first, many people do not realize that they have cataracts. However, cataracts can lead to vision loss without treatment.
Going for regular eye exams may help a doctor detect cataracts before symptoms become apparent.
It is best to see an eye doctor, or ophthalmologist, upon noticing any cataract symptoms. Cataracts are treatable, and surgery is usually successful.
A person should see their doctor if they notice any of the following symptoms:
- blurred or cloudy vision
- double vision
- difficulty seeing at night
- seeing a halo around lights
- colors appearing similar
- needing more light to read
Although some symptoms may indicate other eye problems, a person can visit an eye doctor to rule out cataracts.
Cataracts are some of the most common eye conditions to affect older adults. However, cataract surgery is usually successful. Medicare pays for cataract surgery as long as the doctor agrees that it is medically necessary.
The cost of cataract surgery may vary. Medicare usually covers 80% of the surgical costs.
People may wish to use supplemental plans, such as Medigap, to cover the remaining 20%.
For information about funding cataract surgery, it is best to speak to the insurance provider directly with specifics relating to your procedure.
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