What’s The Best Medicare Advantage Plan For Cataract Surgery
Medicare Advantage plans unify your Medicare coverage, bringing together Part A, Part B, prescription drug benefits and additional cost-savings for health care.
These plans are similar to traditional health insurance, and you’ll usually have a copayment for each procedure or type of medical care. If you’re expecting to have a procedure like cataract surgery, choosing a Medicare Advantage plan with low copayments can help keep your costs from piling up for each appointment or procedure.
Medicare Advantage plans can also be a good tool for managing eye conditions. Plans that include vision insurance can give you routine care from an optometrist as well as access to medical eye care from an ophthalmologist.
Medicare Advantage plans we recommend
- Good coverage for prescriptions
- Vision insurance
What Are Other Medicare Coverage Options For Cataract Surgery
You have other options to help manage your cataract surgery costs. A Medicare Supplement plan may cover all or part of certain out-of-pocket costs, such as your deductibles, copayments, and coinsurance amounts. Many people choose a Medicare Supplement plan, or Medigap plan, to help manage their health-care costs in Original Medicare. Some plans also cover Part B excess charges that may apply these charges are the difference between the amount Original Medicare covers for a given service and what your doctor charges. Youre usually responsible for paying this difference if your doctor charges above the Medicare-approved amount, but some Medicare Supplement plans include benefits that cover these costs.
Treatment For Cataracts Other Than Surgery
Your doctor may not recommend surgery if your cataracts are not too severe. In this case, they may prescribe new prescription glasses or contacts, anti-glare sunglasses, or a magnifying glass.
If your doctor suggests that surgery is not warranted and recommends non-surgical treatment, Original Medicare will not cover the treatment. But the good news is that some Medicare Advantage Plans will include separated vision benefits that will significantly reduce your out-of-pocket expenses.
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Medicare Part B: Glasses And Contacts
If you get cataract surgery that implants an intraocular lens, Medicare Part B will cover you for one pair of glasses or contacts following the surgery. If you want more coverage for vision benefits, you can enroll in Medicare Advantage. Or, you can apply for a separate vision insurance plan.
As you consider whats right for your needs, keep in mind that you may pay an extra premium for vision insurance or Medicare Advantage. This is in addition to the premium you pay for Medicare Part B.
Where Can I Ask Questions About Cataract Surgery And Medicare
If youre enrolled in Original Medicare, you may call Medicare at 1-800-MEDICARE for questions about coverage of cataract surgery.
You can also compare Medicare Supplement plans online to find out if a plan is available near you that can help cover the out-of-pocket Medicare costs of cataract surgery.
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Does Medicare Cover Cataract Surgery
In general, Medicare covers traditional cataract surgeries if they are medically necessary and the treating doctor accepts Medicare for payment.
About 50% of adults have cataracts or have undergone cataract surgery by the time they reach 80 years of age.
Typically, Medicare Part B which is outpatient insurance pays 80% of the expenses related to cataract surgery. This includes one pair of glasses following the surgery.
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 3.6 million people in the United States undergo cataract surgery every year.
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.
The plan covers the following services:
Eyeglasses And Contacts After Cataract Surgery
If you undergo standard cataract surgery, you may need to continue using glasses or contacts.
Medicare Part B will cover 80% of the cost of conventional contacts or eyeglasses after your surgery. If you pick more expensive frames, youll need to pay the difference. Be sure to ask your optometrist about what Medicare will cover. Your out-of-pocket cost can vary depending on the lens selected.
Before you buy, make sure your supplier has a Medicare supplier number. Medicare wont pay your claim without one. Also, tell your optometrist to send the bill to Medicare.
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Medicare Part B And Eye Exams
Routine vision exams arent covered under Medicare Part B unless youre a high-risk individual.2 But these exams are important in detecting eye issues at an early stage, so you can take the right steps to help correct them. If youre interested in this benefit, there are a couple of ways to apply for vision insurance.
How Much Does Cataract Surgerycost
In the Dallas-Fort Worth area, cataract surgery, including your doctor visits after the surgery, costs about $3,500 per eye if you dont have insurance.
The total cost of cataract surgery could bemore or less depending on what type of intraocular lens your doctor uses,whether the doctor uses a laser during the procedure and whether your cataractsurgery is done in the hospital or an outpatient surgery center.
Its important to talk over your choice of IOL before you have cataract surgery with Original Medicare. Medicare covers the cost of a monofocal lens, but your doctor may suggest a premium IOL if you have astigmatism or presbyopia . If you choose one of these premium lenses, expect to pay $1,000 or more out-of-pocket for the upgrade.
In our private Facebook group for Medicare beneficiaries, several members had shared that when they opted for the laser surgery and paid the difference it cost them around $1,000 -1,200 more per eye.
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Does Medicare Pay For Laser Cataract Surgery In 2022
If you require cataract surgery, Medicare will cover the procedure. In 2022, Medicare will pay the same amount for the surgery whether your Medicare-approved doctor uses a laser or not. If there is a cost difference between the two procedures, you will be responsible for additional costs because Medicare wont pay more for a more expensive procedure.
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*Please check with your plan for more information on details of your benefits coverage. This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician or qualified healthcare professional.
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Does Medicare Cover Vision
Home / FAQs / Medicare Coverage / Does Medicare Cover Vision
Original Medicare routine vision coverage is not comprehensive. However, you have options when it comes to coverage for severe eye conditions. Your eyes work hard for you, and they deserve high-quality care. In some cases, this is possible with Medicare. In this article, we go over all the costs, coverage, and benefits of vision care.
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How Does Medicare Cover Cataractsurgery
Whether you have Original Medicare or Medicare Advantage, Medicare and your plan cover costs associated with cataract surgery. Specifically:
- Part B covers the cost of the outpatient surgery center, doctors fees, and other expenses associated with outpatient surgery. Once you meet the Part B deductible, Medicare pays 80% of allowable charges.
- Part A covers your hospital stay if your cataract surgery takes place in the hospital instead of an outpatient facility. You pay a separate Part A deductible if your cataract surgery requires an inpatient stay.
- Part D pays for any drops and medications your doctor prescribes before and after your cataract surgery.
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What Is Cataract Surgery
Cataract causes the lens of your eyes to become cloudy and increases the glare from the light which will affect your vision and can make it difficult to carry out day-to-day activities.
Cataract surgery is a procedure to remove the lens of your eye and replace it with an artificial lens called an intraocular lens .
Cataract surgery is a common eye procedure and generally considered a safe procedure.
Additional Questions To Ask Your Doctor Before 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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Does Medicare Cover Glasses Contacts And Other Lenses For Cataracts
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.
Estimating Your Costs For Medicare Cataract Surgery
The services you need can vary, so the costs will depend on your specific circumstances. But you can get an idea of your estimated cost by following these steps:
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What Does Cataract Surgery Cost With Medicare
According to Medicare.gov, having cataract surgery at an ambulatory surgical center costs about $1,789 . Medicare pays $1,431 of that total, which means the patient pays $357.
Having cataract surgery with a hospitals outpatient department, on the other hand, costs $2,829 . Medicare pays $2,263 of that total, so the patient pays $565. These estimates vary based on where you live and the complexity of your cataracts.
The cost of cataract surgery with Medicare Advantage varies widely based on your specific plan. Contact a customer service representative with your provider to discuss what you can expect to pay before undergoing the procedure.
Cataract Surgery Cost Faqs
Does Medicare pay for cataract surgery in 2022?
Medicare Part B covers cataract surgery with placement of monofocal lenses.
Does Medicare cover all of the cost of cataract surgery?
No, Medicare covers 80 percent of the cost of cataract surgery, which includes exams, standard surgery, and one set of eyeglasses or contacts following surgery.
What percentage of cataract surgery does Medicare cover?
Medicare covers 80 percent of the cost of cataract surgery. You can expect to pay 20 percent once youve met your deductible.
How do Medicare deductibles work for cataract surgery?
A deductible is a payment you pay out of pocket before Medicare begins covering your costs. Insurance experts explain that deductibles are different for different parts of Medicare.
For instance, if you received an outpatient cataract surgery covered by Part B, you would first pay a deductible of $233. This payment covers the deductible.
You will usually pay 20 percent of the cost of procedures covered by Medicare. Medicare would cover 80 percent of the remaining costs.
For 2022, the Medicare Part A deductible covers certain hospitalization costs and works a little differently. The deductible is $1,556 for each benefit period. A benefit period starts the day you enter the hospital and ends after you have not needed inpatient care for 60 consecutive days. If your cataract surgery is done in a hospital, you may be using Medicare Part A to cover expenses.
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What Does Cataract Surgery Typically Cost
With or without Medicare coverage, cataract surgery costs a lot more at a hospital outpatient facility than at a standalone surgical center, also called an ambulatory surgical center.
Under Medicares 2022 payment structure, the national average for allowed charges in outpatient hospital units was $2,079 for the facility fee and $548 for the doctor fee for surgery on one eye. Of the $2,627 total, Medicare paid $2,101 and the patient copayment was $524.
Costs were significantly lower at standalone surgery centers, due to the difference in facility fees. The doctor fee was paid at the same level, $548, but the facility fee was $1,039, half the price for the hospital outpatient procedure. Of the $1,587 total, Medicare paid $1,269 and the copay was $316.
Additional costs may apply patients with complex cases might require more than one doctor, for example. To reduce the chances of a surprise bill, request information from doctors, facilities and Medicare before the procedure.
Cataract Surgery: Is It Medically Necessary
Medicare will only cover your cataract surgery if it is deemed as being medically necessary. In the majority of instances, procedures like cataract surgery will be deemed medically necessary. However, it will be useful to make sure that this is the case before you proceed with the surgery. Otherwise, if you discover that Medicare will not pay for it after the fact, it could put you in a real financial bind.
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What You Need To Know:
- Cataracts are a cloudy area in the lens of your eyes that cause blurry vision, faded colors, sensitivity to light, and double vision
- More than half of all Americans age 80 or older have cataracts or have had surgery to rectify the condition
- Without insurance, cataract surgery typically costs between $3,783 and $6,898
- Original Medicare doesnt usually include vision coverage, but it does cover cataract surgery
- To qualify, cataract surgery must be done with traditional surgical techniques or lasers
- Medicare Advantage plans also cover cataract surgery
Over 24 million people have cataracts or have had surgery for cataracts, and that number is expected to double by 2050.
Cataracts, an eye condition that can cause blurry vision and sensitivity to light, typically require surgery. Without insurance, the procedure can be very expensive. Will Medicare pay for that high cost?
While Medicare doesnt typically cover vision care, such as glasses or contact lenses and eye doctor visits, cataract surgery is the exception. Medicare will pay for cataract surgery if its done using traditional surgical methods or lasers.
Are There Alternatives To Surgery For Cataracts
Some patients may do well, at least in the early stages of cataracts, by taking measures to improve their cloudy vision without surgery. Brighter lights, anti-glare sunglasses, a magnifying lens for close activities, and updated prescription lenses can help. But when recommended by doctors, surgery is a safe and effective long-term solution.
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Medicare Advantage Plans And Cataract Surgery
Medicare Advantage plans, sometimes called Medicare Part C, are sold by private insurers that contract with Medicare. These plans are required to provide the same coverage as Original Medicare, but they may provide additional benefits and coverage.
At a bare minimum, a Medicare Advantage plan will cover all the cataract surgery costs that Original Medicare covers. But you should check with your plan to find out what your benefits are and how much you may have to pay out-of-pocket for the surgery, since costs will vary from plan to plan.
You should also find out what additional cataract surgery benefits your plan may offer that you could take advantage of.
