When Does Medicare Pay For Cataract Surgery
Medicare Part B and all Medicare Advantage plans cover preoperative and postoperative eye exams, the removal of the cataract, the insertion of basic lens implants and one set of prescription eyeglasses or one set of contact lenses following the procedure.
Hospitalization is typically not needed for cataract surgery. But should hospitalization occur as a result of any complications, your hospital stay will be covered by Medicare Part A and all Medicare Advantage plans.
There are two main types of cataract surgery, phacoemulsification and extracapsular. Medicare provides coverage for both.
How To Find A Cataract Surgeon Who Accepts Medicare
Ophthalmologists are eye doctors who specialize in vision correction and care. Many times your ophthalmologist will perform your cataract surgery.
Since not every ophthalmologist will accept Medicare Advantage and you may not want to go through the trouble of finding another healthcare provider, then ask your health insurance provider to give you a Medicare eye doctor list.
However, it may be a little more difficult to find a cataract surgeon who accepts Medicare in 2020 because the physician fee schedule has changed since last year. Eye surgeons have had to take a 15% cut in reimbursement compared to Medicare coverage for cataract surgery in 2019.
So another option is to use the Medicare.govs physician compare tool to help you find an eye surgeon who accepts Medicare.
to get started. First youll come to the physician finder tool. Enter your zip code in the search bar beside the red arrow. We used 37209, which is our corporate offices zip code in Nashville, TN.
Then type ophthalmology in the search bar above the green arrow. Then click Search beside the yellow arrow.
Then youll come to a list of ophthalmologists who currently accept Medicare. Use the contact info to call different doctors to find the right fit.
Ama Disclaimer Of Warranties And Liabilities
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Recommended Reading: Is Shingrix Vaccine Covered By Medicare
What If You Need Cataract Surgery
Once your cataracts begin interfering with your daily activities, like watching TV, reading, or driving, your doctor may decide it’s time to have them surgically removed.
According to the NEI, cataract surgery is very safe, and 9 out of 10 people who get it can see better afterward.
The day before surgery, you’ll probably need to use some special drops in your eye that your doctor will prescribe, and you won’t be able to eat anything after a specific time.
On the day of the surgery, someone will need to take you since you won’t be able to drive yourself home.
Typically, patients are awake during cataract surgery. Your doctor will :
- Put numbing drops into your eye to keep you from feeling anything
- Use tiny tools to cut into your eye, break up the lens, and take it out
- Place the new artificial lens in your eye
Then, you’ll rest in recovery for a little while to ensure you don’t have any problems before they let you go home.
After you get home, you’ll have eye drops to put in your eyes, and you may need to wear a special eye shield or glasses. You’ll also have to avoid touching your eye, bending over, and lifting heavy objects for a few weeks.
After cataract surgery, the doctor will send you home with drops to put in your eyes. These are antibiotics and anti-inflammatory drops that will combat infection and inflammation.
You should start to feel better after a couple of days and be entirely healed after about eight weeks.
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.
You May Like: What Are All The Parts Of Medicare
Does Medicare Cover Cataract Surgery In 2021
In a word, yes. When medically indicated, cataract surgery is covered by Medicare and commercial insurances. Medically indicated means that the patient must be experiencing symptoms and have some disability from the cataract in some cases they may be required to meet certain visual acuity thresholds. Your eye doctor can help determine if a cataract is visually significant.
With that said, there are a number of ancillary services and options that can be performed in conjunction with basic cataract surgery that are not covered by Medicare or commercial insurance. One example would be the type of lens implant placed during cataract surgery, non-covered IOL options include lenses that correct astigmatism and also those that correct presbyopia, allowing a patient to see at distance and up close without glasses.
It is also important to note that despite cataract surgery being covered by Medicare and commercial insurance, it is still subject to deductibles, copays, and co-insurance. See this page to learn more about the cost of cataract surgery.
How Much Does Medicare Cover
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.
Does Medicare Cover Secondary Cataract Surgery
Even after successfully removing a cataract in your eye/s, another one can still reoccur. It can happen again just weeks or months after the cataract-removal surgery.
Though Medicare covers cataract surgery, a common question many people have is, Does Medicare cover secondary cataract surgery? In this article, we answer that question in clear, plain English. You will also find the average costs of secondary cataract surgery, as well as other helpful info.
Medicare Part D Coverage For Cataract Surgery
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 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.
- 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.
Recommended Reading: Does Medicare Pay For A Nutritionist
Learn More About Medicare And Cataract Surgery
A licensed agent with Medicare Plan Finder may be able to find plans in your area that fit your budget and lifestyle needs.
Are you interested in learning about available plans in your area? Fill out this form or give us a call at 1-855-783-1189 to schedule a no-cost, no obligation appointment with a licensed agent.
Medicare Advantage And Cataract Surgery
Medicare Advantage covers cataract surgery. Your private health insurance provider may cover the full cost of cataract surgery on the condition that you pay outpatient surgery copayments or a deductible. Contact your Medicare Advantage plan provider to see which costs are covered and what youll have to pay out of pocket depending on your plan.
To learn more about this type of coverage, read my guide Medicare Advantage vs. Medigap.
You May Like: Does Medicare Cover Outpatient Mental Health Services
Don’t Miss: Is There A Copay With Medicare Part D
What To Expect During An Exam
If you’re experiencing any symptoms of cataracts, your eye doctor will probably do a dilated eye exam.
Having your eyes checked is critical to the early detection of cataracts. The eye doctor will do a thorough exam, especially if you’re experiencing any cataract symptoms.
A dilated eye exam is painless and straightforward. Your doctor will give you some eye drops that’ll dilate, or widen, your pupils so he can look for any eye diseases.
During a dilated eye exam, your doctor will perform :
- A visual acuity test to check how clearly you see. Your doctor will ask you to read letters that are up close and far away.
- A visual field test to check your peripheral vision. Your doctor will test how well you can see objects off to the sides of your vision without moving your eyes.
- An eye muscle function test to check for problems with the muscles around your eyeballs. Your doctor will move an object around and ask you to follow it with your eyes.
- A pupil response test to check how light enters your eyes. Your doctor will shine a small flashlight into your eyes and check how your pupils react to it.
- A tonometry test to measure the pressure in your eyes. Your doctor will use a machine to blow a quick puff of air onto your eye, or gently touch your eye with a special tool. Don’t worry â it doesn’t hurt!
- Dilation to check for problems with the inner parts of your eye. Your doctor will give you some eye drops to dilate your pupil, helping him see inside your eye.
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
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.
Recommended Reading: Is Shingles Shot Covered By Medicare Part D
Questions To Ask Your Healthcare Provider About Cataract Surgery
Policies vary widely from one insurance provider to the next.
Here are some questions you should ask your health care representative regarding cataract surgery:
- How much is my deductible?
- How much is my co-pay?
- Does my plan pay for prescription eyeglasses after surgery?
- Are you a preferred provider for any eye surgeons or surgery centers?
- If my eye surgeon is not a preferred provider do I need to get your approval before covering the procedure?
- Do you require advanced approval from a doctor to validate the medical necessity of my surgery?
In this article
When Do Blue Cross Blue Shield Medicare Plans Pay For Cataract Surgery
While benefits may differ from one plan to another, Blue Cross Blue Shield Medicare Advantage plans will generally cover cataract surgery that implants a monofocal intraocular lens. If a more advanced lens is used for the implant, it may or may not be covered.
Its common for a patient to be prescribed a pair of eyeglasses following cataract surgery, or for a previous prescription to be modified after the procedure. A Blue Cross Blue Shield Medicare that includes BCBS Medicare vision coverage will typically help pay for some of the following:
- Routine vision exams
- Retinal imaging
Don’t Miss: What Age Can You Begin Medicare
How Medicare Works With Cataract Surgery
Overall, cataracts are considered serious medical issues by health insurers, hence they cover most of the treatment costs. Medicare will cover expenses related to basic management of cataracts, including the removal of lenses and replacement with an artificial one.
Medicare comprises different parts, which cover various services. These include:
- Part A, which covers inpatient programs like stays in skilled nursing facilities and hospitals.
- Part B, which covers some elements of outpatient care, doctors services, and preventive care.
- Part C , which allows patients to pick an extra private insurance plan, covering ailments that might not be fully covered under the federal program.
- Part D, which covers prescription drugs.
Most Medicare recipients get most of their conditions covered by Parts A, B, and D. Since Part C was added, Medicare-approved health insurance programs are more easily available to older adults who need additional coverage for their medical conditions or want added levels of care beyond the basic coverage for procedures like cataract surgery.
Since cataracts can impact your safety and quality of life, they are considered a medically necessary procedure, so Medicare will cover much of the cost of the surgery. While the program does not typically cover vision problems, cataracts lead to problems beyond just fuzzy vision. When untreated, they can lead to blindness.
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:
Read Also: What Is Medicare Plan C
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
Medicare And Cataracts: Taking The Fear Out Of Removing Cataracts
According to the World Health Organization, cataracts are the leading cause of blindness in the world. The most obvious symptom is clouded vision. The word cataract actually means waterfall because, with cataracts, it can seem like youre looking through a sheet of water.
If youre diagnosed with cataracts, this isnt necessarily a cause for alarm. According to the National Eye Institute, this condition is a normal part of the aging process and is common among people over age 60. As such, Medicare covers the surgery required to correct cataracts, as well as glasses or lenses if they are necessary after the surgery.
According to the American Optometric Association, there are different types of cataracts: nuclear, cortical, and posterior subcapsular cataracts. These are found on different parts of the eye. If you have multiple cataracts, doctors typically remove them one surgery at a time. Cataracts in your other eye may be removed at a different time as well.
In cataract surgery, the natural lens of the eye that has the cataracts is removed and replaced by an artificial lens. The surgery can be performed on an outpatient basis, and only an ophthalmologist can perform this type of surgery.
Surgery isnt necessarily the only way to deal with cataracts. Talk to your doctor about your options and what may be best for your situation.
Read Also: Can People On Medicare Use Good Rx