In general, Medicare covers traditional cataract surgeries if they are medically necessary and the treating doctor accepts Medicare for payment.
If cataract surgery requires a hospital stay, Medicare Part A — which is hospitalization insurance — will cover it. Medicare Advantage, or Medicare Part C, plans provide the coverage of parts A and B.
This article explains the costs of cataract surgery and which expenses Medicare will and will not cover.
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.
As of 2015, researchers estimate that about
Since surgeons generally perform cataract surgery on an outpatient basis, it falls under Medicare Part B. This covers certain post-surgical costs. Usually, Medicare pays 80% of the total surgical cost, consisting of the procedure itself and the facility charges.
Medicare does not normally cover prescription glasses. The exception is one pair of spectacles or contact lenses after cataract surgery.
The plan covers the following services:
- pre-operative exams
- removal of the cataract
- implantation of the lens
- postoperative exams
- one pair of prescription glasses after the surgery
Because various factors can affect the cost, people should check their annual deductible for Medicare Part B.
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 Advantage, or Medicare Part C, plans are the alternative to traditional Medicare. Because of this, they need to provide at least the same coverage for everything, including cataract surgery.
Medicare Part D is a prescription drug plan available to people who have Medicare parts A and B. If a person with a Part D plan needs a prescription drug to take at home following cataract surgery, their plan will likely cover part of the cost.
Medicare supplement plans, also known as Medigap plans, are private insurance policies that help people pay the 20% of costs excluded from Medicare coverage. For instance, these plans may pay deductibles, copayments, and other out-of-pocket expenses.
Any person with Medicare parts A and B can apply for a supplement plan. Costs vary. A person with a Medicare Advantage plan is not eligible to buy a Medigap plan.
Although Medicare usually covers cataract surgery that a doctor deems medically necessary, the requirements for coverage vary between regions. Before undergoing the procedure, a person may wish to check the regulations of their local Medicare carrier.
Medicare does not cover the remaining 20% of the cost of cataract surgery. Plans may also exclude certain other charges, including deductibles and medications such as eye drops.
An individual’s share of the cost of cataract surgery depends on the type of operation they need to have.
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 individual to pay the difference between the covered amount and the additional costs of laser surgery.
During cataract surgery, a 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, however, which surgeons typically use.
Although other lenses, including multifocal and toric lenses, are available, Medicare may not cover these. It also does 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 determine 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 determine potential out-of-pocket costs, a person should ask the following questions before their 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 before and after surgery?
It is also good practice to ask for the Medicare code for the procedure, as this will help a person more accurately determine coverage through this online tool.
Some researchers have found prices in the range of almost
However, the cost of cataract surgery can vary among states and individuals. For example, it may cost more depending on the type of procedure a person undergoes and whether the surgery takes place at an outpatient surgical center or a hospital.
Surgeon fees also vary, which may affect the total cost of the procedure. In addition, the type of lens implant changes the price.
It is best to discuss the overall charges with the surgeon for the most accurate picture of the eventual cost.
Cataracts are some of the most common eye conditions to affect older adults. Surgery to correct them 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 Medicare supplement plans, such as Medigap, to cover the remaining 20% of the cost.
For information about funding cataract surgery, it is best to speak with one’s insurance provider directly.