Wednesday, April 27, 2022

Do Medicare Advantage Plans Cover Cataract Surgery

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How Much Does Medicare Cover

Does Medicare Cover Cataract Surgery?

Once its determined by your doctor that surgery is necessary for your cataracts, Medicare will normally cover 80% of the costs. This includes all preoperative and postoperative exams, surgical removal of the cataract, implantation of the new lens, and a pair of eyeglasses or contacts.

Though Medicare normally doesnt pay for eyeglasses or contact lenses, one post-operative pair is the only exception.

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How Much Will Cataract Surgery Cost Without Supplemental Coverage

If you have Original Medicare without Medigap, you will be responsible for 20% of the approved Medicare charges for your procedure after you have met your annual Part B deductible.

Assuming that your cataract surgery will be an outpatient procedure, there are a couple of ways you can try to determine your out-of-pocket costs:

  • Use Medicares tool to look up the price of your procedure. Costs are based on national averages and include facility and doctor fees. Additional costs may apply. For instance, if you have a common and uncomplicated procedure at an ambulatory surgical center, you pay $316 after Medicare pays its portion. The facility costs are higher if you have the same procedure at a hospital outpatient department. In that case, the average patient cost is $524. Note: these costs are for one procedure on one eye.This tool can give you a ballpark dollar amount to work with, but the costs in your area and the complexity of your procedure may be very different.
  • For a more accurate estimate, contact the billing department of your Medicare provider and ask for a cost rundown based on what type of surgery you will have and which type of facility it will be in. They are trained and experienced in billing Medicare and should be able to provide you with fairly accurate information, barring any unforeseen complications that may happen during your procedure or recovery period.You may want to ask these questions:
  • What Is A Cataract

    A cataract is a clouding of the lens in your eye. Early cataracts are small and do not affect vision, though they may be detected in an eye exam.

    As a cataract grows over time, it clouds more of the eye lens and affects vision. Vision changes caused by cataracts may include:

    • Bright glare from headlights, lamps, or sunlight
    • Difficulty seeing at night

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    Cataract Surgery: What Are Cataracts

    Cataracts are a clouding in your eyes natural lenses. Once cataracts form, the lens becomes increasingly opaque as cataracts interfere with light getting through to your retina. You can have cataracts in one eye or both.

    Outpatient cataract surgery is typically covered under Medicare Part B benefits, while inpatient surgery is usually covered under Medicare Part A. You may have greater coverage and lower out-of-pocket costs if you have a Medicare Advantage or Medigap plan.

    The actual cause of cataracts is unknown. However, the breakdown of lens proteins and other chemical changes associated with aging are contributing factors to cataracts.

    Does Medicare Cover Glasses Contacts And Other Lenses For Cataracts

    Does Medicare Cover Cataract Surgery?

    Medicare Part B will pay 80 percent of the Medicare-approved cost for one pair of glasses with standard frames or one set of contact lenses following each cataract surgery to implant an intraocular lens.

    You have to pay the remaining 20 percent plus any additional cost for upgraded eyeglass frames.

    Following cataract surgery, Medicare will only pay for glasses or contact lenses from a Medicare-enrolled supplier. Check to make sure the supplier is enrolled in Medicare.

    Cataract surgery is one of only a few exceptions in which Medicare will pay for glasses or contact lenses.

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    Learn More About Medicare

    There are Medicare options that can help cover some of your vision needs.6 So you can rest assured knowing you wont miss out on seeing your grandkids sports games or reading your favorite books!

    1,2,6 Medicare.gov. Web page: Eye Glasses/Contacts. Retrieved on July 31, 2018, from website 3 All About Vision . Web page: Choosing A Vision Insurance Or Vision Benefits Plan. Retrieved on January 14, 2019, from website 4,5 Medicare.gov. Web page: I have a pre-existing condition. Retrieved January 14, 2019, from website

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    Does Medicare Advantage Cover Cataract Surgery

    So, does Medicare cover cataract surgery? Which parts of Medicare cover cataract surgery?

    Medicare Part B covers cataract surgery as long as the surgery is completed using either traditional methods or lasers. Since Medicare Advantage plans have to be the same or better than original Medicare, these plans will cover the cataract surgery as well.

    Medicare covers what is called an intraocular lens implant, which is a small disk that is implanted after the removal of cataracts to help with focusing your vision. However, Medicare will only cover the basic implant rather than the advanced ones.

    Medicare Part D Coverage For Cataract Surgery

    Medicare Explained: Does Medicare Cover Cataract Surgery and Glasses?

    Medicare Part D prescription drug coverage can help you pay for the prescription drugs you will need following cataract surgery.

    Types of Drugs Typically Prescribed Before or After Cataract Surgery

    Antibiotics
    Antibiotics are often prescribed to prevent endophthalmitis, a rare but serious complication that can follow cataract surgery along with other bacterial infections. They are prescribed for a few days before surgery until a week or two after.
    Corticosteroids
    These steroids can reduce inflammation caused by the trauma of surgery and the release of lens proteins that can result in a painful, red eye. You usually take these medications for a few weeks following surgery.
    Nonsteroidal Anti-Inflammatory Drugs
    These are anti-inflammatory drugs that work differently and can be used in conjunction with corticosteroids. Many are over-the-counter medications such as aspirin, Advil and Aleve. Other drugs in the class, such as Celebrex, may require a prescription.

    If you have Original Medicare, youll have to purchase a separate Part D prescription drug plan, but these plans are often included in a Medicare Advantage plan. You should check if a Part D plan is included before purchasing a Medicare Advantage plan.

    Some medications related to your immediate surgery may be covered by Medicare Part B, but only if Medicare considers them to be medical, rather than prescription drug, expenses.

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    Is There Any Other Cost Related To Cataract Surgery That Medicare Will Cover

    Though Medicare covers 80% of the cost of cataract surgery with intraocular lens implants, more advanced procedures may need you to fund a larger portion, or perhaps the entire cost.

    After your operation, Medicare will cover one pair of glasses, but things like updated frames, additional pairs of contact lenses, and other treatment-related products like eye drops are unlikely to be covered. Its also crucial to talk to your healthcare provider about what is and isnt covered under your plan to avoid any unexpected expenditures.

    Medicare And Routine Eye Care

    Routine eye care services, such as regular eye examinations, are not covered by Medicare. If you have a chronic eye problem like cataracts or glaucoma, Medicare will fund some eye care services. Medicare pays for the following:

    Surgical treatments to aid in the repair of eye function caused by chronic eye diseases. For example, Medicare will pay for cataract surgery and the replacement of your eyes lens with a manufactured intraocular lens.

    If you had cataract surgery and had an intraocular lens implanted in your eye, youll need eyeglasses or contacts. If you need a basic pair of untinted prescription eyeglasses or contacts, Medicare will fund them. Medicare may pay for customised eyeglasses or contact lenses if they are medically required.

    An eye exam is performed to determine whether or not you have any visual difficulties.

    Medicare will fund an eye checkup if you are experiencing vision issues that could signal a serious eye condition.

    Only the following situations are covered by Medicare for routine eye care:

    If you have diabetes, Medicare will pay for an annual eye exam by a state-licensed eye doctor to screen for diabetes-related visual issues.

    Medicare pays an annual eye exam by a state-authorized eye doctor if you are at high risk for glaucoma. If you do any of the following, you are considered to be at high risk:

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    Questions To Ask Your Eye Doctor Before Cataract Surgery

    • Do they accept Medicare?

    • What is the Medicare code for the specific procedure you plan to have?

    • Where will the procedure be performed: a surgical center or a hospital?

    • Will this be an inpatient or outpatient surgery?

    • Will you require any prescription medications before or after the surgery? If so, which ones?

    Your eye surgeon should be willing to discuss with you the different options available and the associated costs not covered by Medicare. From this consultation, you can decide what you do and dont want done during your cataract surgery, based on your priorities and budget.

    For example, Medicare Part B covers basic cataract surgery and intraocular lenses , but it will not cover the added cost of certain premium IOLs or procedures. However, choosing a premium IOL or an additional procedure, such as limbal relaxing incisions to correct astigmatism, may significantly improve satisfaction with your vision after surgery and be worth the added expense.

    The pre-surgery exam is an opportunity for you and your cataract surgeon to gain a shared understanding of whats to be expected during and after your cataract surgery.

    And dont hesitate to ask questions about costs, insurance, etc. If your surgeon is unsure about a particular Medicare question, reach out to a Medicare representative in your area to get an informed answer.

    For Other Resources On Cataract Surgery And Medicare Coverage See:

    Does Medicare Cover Cataract Surgery?

    Medicare.gov, Cataract surgery, https://www.medicare.gov/coverage/cataract-surgery.html

    National Institutes of Health, National Eye Institute, Facts About Cataract, nei.nih.gov/health/cataract/cataract_facts

    New To Medicare?

    Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

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    How Much Does Medicare Cataract Surgery Cost With No Extra Coverage

    According to Healthcare Bluebook, a fair price for cataract surgery would cost $4,366.1

    Medicare Part B covers 80% of standard surgery once you meet your annual deductible.

    For example, say you need cataract surgery on one eye, and it costs $4,366 for the standard procedure. You would need to pay 20% after you meet your deductible. The table below gives a breakdown of the costs:

    Cataract Surgery
    $233$1,059.60

    The cost of your surgery will depend on several factors including the type of intraocular lens you get, the technology used, and the surgeon who performs it.

    If you undergo laser cataract surgery, you will likely need to pay the added costs yourself. This is also the case if you receive a premium toric IOL for astigmatism or a presbyopia-correcting IOL.

    Can Medisave Be Used For Cataract Surgery

    While it is a day surgery procedure, cataract surgery is Medisave claimable, subject to the approved surgical limit. In addition, if you have an Integrated Shield Plan, you can claim part or all of your cataract surgery cost, depending on your private insurance coverage, for both private and public hospitals.

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    Does Humana Cover Cataract Surgery

    • Humana Medicare plans cover cataract surgery, and most Humana Medicare Advantage plans cover additional vision benefits that Original Medicare dont cover. Learn more and compare Humana Medicare plans available where you live that cover cataract surgery.

    The average cost of cataract surgery is between $3,500 and $7,000 per eye. But with a Humana Medicare Advantage plan, your actual costs will typically be far less.

    Thats because all Humana Medicare Advantage plans cover cataract surgery. Medicare Advantage plans are required to cover everything that Original Medicare covers, which includes medically necessary cataract surgery. Because all Medicare Advantage plans must cover the surgery, that means Humana Medicare Advantage plans also cover it.

    Many Humana Medicare Advantage plans also offer additional vision benefits that arent covered by Original Medicare. Learn more and find out how to compare Humana Medicare plans near you that cover cataract surgery and other vision benefits.

    Additional Questions To Ask Your Doctor Before Cataract Surgery

    Medicare Coverage – Medicare Vision Coverage: Does Medicare cover Cataract Surgery

    Elizabeth Chiang, M.D., an ophthalmologist and oculoplastic surgeon based in Brecksville, Ohio, suggests patients ask their eye doctor the following questions during a cataract surgery consultation:

    • Am I at a higher risk than others for any complications?
    • WIll you be performing my surgery? If not, who will be operating on me?
    • Will you see me for my post-op visits, or will I be seeing someone else?
    • Do you do dropless cataract surgery, or will I have to use eye drops after surgery?
    • Will I wear an eye patch after surgery? If so, for how long?

    If you have glaucoma, ask if any other procedures will be done during your cataract surgery to treat it, adds Dr. Chiang.

    Medicare.gov suggests asking your eye doctor the questions below before any procedure, including cataract surgery:

    • Which hospitals or surgical centers do you work with?
    • Which facility is best for me, based on my health status?
    • What happens if I have a medical emergency while Im at an ambulatory surgical center, which is not a hospital?
    • If I have a Medigap plan, do I need to use a certain hospital or surgical center?
    • Does my Medigap plan require me to get a pre-authorization or referral before having cataract surgery?

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    How Much Does Cataract Surgery Cost With Kaiser Senior Advantage

    The Kaiser Senior Advantage plan requires no annual deductible. Plan members will owe a copayment or coinsurance for the cataract surgery, which generally includes the removal of the cataract and insertion of an artificial lens. Exams to diagnose cataracts are also covered by the plan.

    Kaiser Senior Advantage then covers eyeglasses or contact lenses following the procedure with a 20% coinsurance requirement.

    If any prescription drugs are needed following the procedure, the Kaiser Senior Advantage plan provides prescription drug coverage and may cover the needed medication.

    Original Medicare Medicare Advantage And Medigap Offer Different Coverages

    Once youve met your deductible, Medicare Part B will cover 80% of the cost of your surgery. Though its rare for hospitalization to be required for this type of surgery, if its deemed necessary, Medicare Part A will cover it as well.

    Medicare Advantage and Medigap supplemental insurance may also offer lower out-of-pocket costs and encompass more elaborate treatments for you, though its likely that your choice of providers will be limited under these plans.

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    How Do I Know If I Need Cataract Surgery

    In the early stages, a cataract may be treated with:

    • Eyeglasses or magnifying lenses
    • Environmental adjustments
    • Anti-glare sunglasses

    If the above solutions arent helping and your vision is impairing your everyday life, you may need cataract surgery.

    During cataract surgery, your doctor will remove the cataract from your lens and replace the cloudy lens with an artificial lens. The operation lasts about an hour your doctor may recommend that you remain awake for the procedure, although in some cases, you may have general anesthesia. Most people go home from surgery the same day, although youll need to arrange to have someone take you home. You may need new prescription glasses or contact lenses once your eye heals.

    Medicare Advantage And Vision Benefits

    Does Medicare Cover Cataract Surgery

    If you want to get additional vision benefits, another way is with a Medicare Advantage plan. Medicare Advantage plans vary by insurance company. Not all plans include vision benefits, so remember to ask when youre deciding which plan you want.

    As for costs, there are Medicare Advantage plans that offer a $0 premium. Ask your Medicare Advantage insurance provider about monthly costs when choosing the plan thats right for you.

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    Medicare Cost Of Cataract Surgery

    The following is an estimate of the cost of cataract surgery:

    • The average total cost in a surgery centre or clinic is $977. Your cost is $195, and Medicare pays $781.
    • The average overall expenditure in a hospital is $1,917. Your expense is $383, and Medicare pays $1,533.
    • These costs do not cover physician fees or other treatments that may be required, according to Medicare.gov. They are national averages that may vary depending on where you live.

    Additional Humana Vision Coverage

    Its important to remember that cataract surgery will generally be covered by the medical insurance portion of your Humana plan and not the vision coverage portion of your plan.

    Vision coverage is typically included in Humana Medicare Advantage plans at no extra cost.

    Humana vision benefits can include:

    • Annual routine vision exams

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    What Medicare Covers Is Not Always Clear

    Q. Does Medicare cover all items and services associated with cataract surgery?A.Q. Which items and services associated with cataract surgery are covered by Medicare?

    A.Q. If we perform both an A-scan and an IOLMaster , may we bill one of the tests to the patient as a noncovered test?A.Q. Does Medicare cover anything else associated with cataract surgery?A.Q. If diagnostic tests are performed in the postoperative period after cataract surgery, are they covered by Medicare?A.Medicare Claims Processing ManualQ. Are Medicare beneficiaries required to sign an ABN before receiving any non-covered items or services?A.Q. Are there diagnostic tests that may be offered to cataract patients that would be considered noncovered by Medicare? A.Q. Are there any noncovered charges for evaluation and treatment of astigmatism at the time of cataract surgery?A.Q. Are there any noncovered charges associated with patients considering pseudophakic monovision? A.Q. Does the patient get to decide whether to have these noncovered tests?A.Q. Are there any noncovered services associated with conventional IOLs within an ambulatory surgery center?A.Q. Does the patient benefit from having these noncovered tests and services?A.Ms. McCune is vice president of the Corcoran Consulting Group. Contact her at .

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