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Does Medicare Cover Cataract Surgery And Lenses

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Does Medicare Cover Laser Eye Surgery For Cataracts

Does Medicare Cover Cataract Surgery?
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Its important to emphasize that medicare will cover one set of eyeglasses or contact lenses after your surgery, even though medicare does not usually offer this coverage. Similar to conventional surgery, laser surgery requires you to pay the additional costs if you require an advanced.

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What Are Cataracts And How Do They Affect Vision

According to the National Eye Institute, a cataract occurs when the lens of your eye becomes cloudy. The lens is the clear part at the front of the eye that helps you to focus on an image. When functioning normally, light enters your eye through the lens and passes to the retina, which then sends signals to your brain that help you process what you see as a clear image. When the lens is clouded by a cataract, light doesnt pass through your eye to your retina as well, and your brain cant process images clearly, resulting in blurry vision.

Cataracts can occur in one or both eyes, but they cannot spread from one eye to the other. Your chances of developing cataracts increase significantly with age.

Some people develop cataracts at a much younger age, such as in their 40s or 50s. However, these cataracts tend to be smaller in size and do not usually affect vision. In general, people dont experience vision problems from cataracts until they reach their 60s.

Abns Are Not A Front Desk Thing:

The ABN is a form that requires special consultation and should be treated as such. The ABN should not be filled out at the front desk, which is where its usually done, says Holt. ABNs should be completed either in the exam lane or in the optical with the optician. That is who has the knowledge of whats going on with that patient for that charge, she advises.

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Common Questions About Cataract Surgery

Does Medicare cover cataract surgery?

Yes, Medicare Part B covers the cost of the outpatient cataract surgery, doctors fees, and other expenses associated with outpatient surgery. If you receive your surgery as an inpatient, Part A covers your hospital stay when your cataract surgery occurs in the hospital.

Does Medicare cover eye glasses after cataract surgery?

Yes, Medicare Part B helps pay for corrective lenses after cataract surgery. Medicare would help cover either one pair of eyeglasses with standard frames or one set of contact lenses.

What are my costs for cataract surgery?

If your cataract surgery takes place in an outpatient facility, you must first meet the Part B deductible, and then Medicare pays 80% of allowable charges. You will pay the Part A deductible if your cataract surgery requires an inpatient stay. When you have a Medigap plan, your plan will help with your out-of-pocket costs. Your cataract surgery cost-sharing with a Medicare Advantage plan would depend on your plans cost-sharing amount.

The Details Regarding The Cost Of Cataract Surgery

Does Medicare Cover Cataract Surgery?

If only there were a simple answer to this question. Every medical and surgical procedure is associated with a CPT code . The CPT code for cataract surgery is 66984, although 66982 is also a cataract surgery code used when the cataract surgery is complex, which can happen for any number of reasons.

When it comes to the cost of any medical or surgical procedure, every doctor, medical office, and hospital comes up with a price for any given CPT code. Think of this as the sticker price. Keep in mind that hardly anyone ever pays the sticker price. When doctors decide to be in-network with any insurance company, they accept and/or negotiate rates for various CPT codes. Also keep in mind that many surgery CPT codes and their associated charges include post-operative visits in that one cost.

As an example, the surgeon fee sticker price for cataract surgery may be $1500, but the surgeon has agreed to accept, say, $900 from Blue Cross Blue Shield . In that case, for a patient with BCBS, the surgeon fee is $900. Now whether it is BCBS or the patient that pays that $900 depends on the actual BCBS plan and any relevant deductibles, co-insurance, and co-payments. In my experience, the average patient would usually have to pay about $150 of this $900 based on the most common plans, with BCBS paying the rest.

Cataract Surgery

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What Does Medicare Cover

Medicare covers the most common cataract surgery procedures that use conventional techniques or computer-controlled lasers to remove the cataract and insert an intraocular lens implant.

  • Phacoemulsification In this, the most common technique, an ultrasonic device is inserted through a small incision in the cornea, which then breaks the lens into pieces that can be extracted with a suction device.
  • Laser-assisted surgery is a newer method that modernizes the traditional manual process with a machine-controlled laser system.

Phacoemulsification and laser-assisted surgery are equally covered by Medicare. Your ophthalmologist can help you decide on the best method.

While Medicare covers the most common monofocal lens involved in cataract surgery, it doesnt cover all types of intraocular lenses. Other lenses, such as multifocal and toric lenses, are generally not covered.

How To Keep Your Additional Vision Care Affordable

Now that you know your cataract surgery may be covered, its a good time to consider your comprehensive vision care. Many Medicare Advantage plans include vision coverage as part of the plans benefits. Additionally, senior vision insurance coverage is also available for those without Medicare Advantage plans. For even more convenience, there are also plans that combine vision, dental, and hearing coverage into a single policy.

Explore your options, compare coverage, and find a plan that suits your vision needs today with HealthMarkets.


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Does Medicare Cover Cataract Surgery

Though Medicare doesnt pay for most vision care, it does cover necessary services such as cataract surgery.

This includes:

  • Implanting a new lens
  • Eyeglasses or contact lenses for use after the surgery

While Medicare covers these basics of regular surgeries, they may not be able to cover more advanced treatments .

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Medicare – Will it Pay For Cataract Surgery?

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How Can I Know If My Lens Implant Is Covered

There are multiple types of cataract surgeries, and some of the more complex or involved procedures that will not be covered by Original Medicare. With most cataract surgeries, the type of lens that is used is called a monofocal lens. It is important to note that Medicare will only cover monofocal lens implants.

Lenses that arent covered by Medicare are:

  • Multifocal
  • Toric

What Does Cataract Surgery Cost

Thereare two main kinds of cataract surgery. Medicare covers both surgeries at thesame rate. These types include:

  • Phacoemulsification. This type uses ultrasound to break up the cloudy lens before it is removed and an intraocular lens is inserted to replace the cloudy lens.
  • Extracapsular. This type removes the cloudy lens on one piece, and an IOL is inserted to replace the cloudy lens.

Your eye doctor will determine which type of surgery is best for you.

According to the American Academy of Ophthalmology in 2014, the general cost of cataract surgery in one eye with no insurance was approximately $2,500 for the surgeons fee, the outpatient surgery center fee, the anesthesiologists fee, the implant lens, and 3 months of postoperative care.

However, these rates will vary by state and the specifics of an individuals condition and needs.

The exact cost of your cataract surgery will depend on:

  • your Medicare plan

cost of cataract surgery with medicare

An estimated cost of cataract surgery may be*:

  • In a surgery center or clinic, the average total cost is $977. Medicare pays $781, and your cost is $195.
  • In a hospital , the average total cost is $1,917. Medicare pays $1,533 and your cost is $383.

*According to Medicare.gov, these fees dont include physician fees or other procedures that may be necessary. They are national averages and may vary based on location.

Medicare covers basic cataract surgery including:

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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.

Does Medicare Cover Routine Eye Care Services

Does Medicare Cover Laser Cataract Surgery?

Generally, no, Original Medicare does not cover eye care. If you are looking for routine vision services, youre better off looking into Medicare Advantage plans. These plans frequently cover vision benefits as well as everything covered by Medicare Part A and Part B.

There are exceptions, though. If you have Medicare Part B, it will cover specific vision care services, but only in certain situations:

  • Age-related macular degeneration tests
  • Regular eye examsif you have diabetes or symptoms of eye disease
  • Yearly glaucoma screeningsif you have diabetes, have a family history of glaucoma, or are African American and over 50 or Hispanic and over 65

If you dont meet these conditions, however, youre out of luck.

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Does Medicare Cover Vision Cataract Surgery Or Glasses

Original Medicare, known as Medicare Part A and Part B, covers quite a few medical services. From preventive care to life-saving procedures, Medicare can help out. But unfortunately, this is not always the case when it comes to vision benefits.

Weve compiled a list of the most frequently asked questions about vision benefits provided by Medicare Part A and Part B.

For Other Resources On Cataract Surgery And Medicare Coverage See:

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

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Does Medicare Pay For Laser Cataract Surgery

Medicare coverage for cataract surgery doesnt depend on the surgical method. Medicare will cover 80% of the cataract removal and basic lens whether the procedure is conventional or bladeless with a computer-controlled laser. Similar to conventional surgery, laser surgery requires you to pay the additional costs if you require an advanced lens.

Are There Alternatives To Surgery For Cataracts

Does Medicare Cover Cataract Surgery

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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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.

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.

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Medigap Provides Coverage For Some Costs

Original Medicare covers quite a bit, but the cost of deductibles, copays, coinsurance and other fees can add up quickly. Medigap, also calledMedicare Supplement Insurance, can help help fill in these coverage gaps.

There are 10 standardized Medigap plan types that are sold by private insurers in most states . Plan availability and cost can vary by state.

Use the chart below to compare the basic benefits of each type of Medigap plan.

80% 80%

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,490 in 2022. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

2 Plan K has an out-of-pocket yearly limit of $6,620 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

3 Plan L has an out-of-pocket yearly limit of $3,310 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

Undergoing Cataract Surgery With Part B

Does Medicare cover Cataract surgery?

Part B covers your outpatient care and is most likely what you will use to cover your cataract surgery. Under Part B, only 80% of the cost of your cataract surgery will be covered. You will be responsible for the remaining 20%. Part B will cover your lens implant, removal, and the prescription glasses or contact lenses covered for the procedure. The Part B deductible is quite low at $198.

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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.

How Can I Enroll An Aetna Medicare Advantage Plan

Contact a licensed insurance agent to learn about any Aetna Medicare Advantage plans available where you live, and be sure to ask about each plans cataract surgery coverage and other vision benefits.

An agent will also be able to review your Medicare Advantage eligibility and help you through the enrollment process.

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What Medicare Does And Doesnt Cover

Generally, Original Medicare pays for 80 percent of the cost of cataract treatment. This includes:

  • Surgery, in which the cataract is removed and an artificial lens is implanted
  • Pre- and postoperative ophthalmologist exams
  • One pair of corrective eyeglasses and contact lenses

Original Medicare includes Medicare Part A hospital insurance and Medicare Part B medical insurance. The eyeglasses or contacts prescribed after surgery fall under Part B coverage. Though hospital expenses are covered under Part A, you likely wont need a hospital stay for cataract surgery.

If you have a Medicare Advantage plan, your insurance provider should pay for both the cataract surgery and the corrective glasses or contact lenses. Medicare Advantage plans are required to provide the base level of benefits offered through Original Medicare coverage.

Under Original Medicare, you are responsible for the remaining 20 percent of expenses, including any deductibles, copayments, or coinsurance involved with cataract surgery and exams.

If you dont want to pay out-of-pocket, you can enroll in a Medicare Supplement plan, which handles extra costs not covered by Original Medicare.

Presurgery eye drops may be covered by Medicare Part B. Any other medications prescribed to you postsurgery, including eye drops, may be covered by a Medicare Part D prescription plan.

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