How Much Does Cataract Surgery Cost Without Insurance
Without insurance, cataract surgery can be very expensive. According to All About Vision, your cost is dependent on your location and the type of cataract surgery you get. If you dont have Medicare or private insurance, cataract surgery can cost between $3,783 to $6,898 per eye as of 2019. Complicated cases such as intraocular lenses for astigmatism or opting for laser cataract surgery can increase your cost.
Finding A Medicare Advantage Plan With Lasik Coverage
In order to enroll in a Medicare Advantage plan, you must first be enrolled in both Medicare Part A and Medicare Part B.
You then must identify the Medicare Advantage plans that are available where you live, as you may only enroll in a plan that services your area. Medicare Advantage plans are sold by many of the same insurance companies you may already be familiar with, like Humana, Aetna, Anthem Blue Cross and more.
Finally, you must find a Medicare Advantage plan that includes LASIK coverage, as not every plan will provide this benefit. Even if a plan includes vision coverage, it may not necessarily cover a LASIK surgery.
There are only certain times of the year in which you may enroll in a Medicare plan. If you are a Medicare beneficiary wanting LASIK eye surgery, talk to a licensed insurance agent about your Medicare Advantage plan options and when you can enroll. With the right insurance coverage, you can see a brighter future for your eyes.
Christian Worstell Author Bio
Christian Worstell is a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN and The Washington Post, and he is a frequent contributor to healthcare and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
How Much 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.
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Find Cheap Medicare Plans In Your Area
Cataract surgery is covered by Medicare, and how much youll pay for the surgery will depend on which type of Medicare plan you have and the plans coverage level. For those who have Medicare Part B, the average out-of-pocket cost for cataract surgery ranges from $207 to $783.
One of our top recommendations is to sign up for Medigap Plan G from AARP, which gives you cataract surgery at a $0 copayment, with an average policy costing about $150 per month. You can also get great coverage with the more convenient Medicare Advantage plan from Aetna, which has cheap monthly rates and includes vision insurance.
What Are My Best Steps For Getting Coverage
If youre considering LASIK, you may be able to take certain steps to get coverage:
The costs for LASIK vary from doctor to doctor and from state to state. Factors that may play a role include:
- your vision
- the type of laser and technology used
- the doctors level of expertise
Youll also need follow-up visits after the procedure to see how your eyes are healing.
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Factors That Affect How Much You Pay
Several factors affect how much you pay for cataract surgery.
Some regions of the U.S. are simply more expensive, and this higher pricing extends to surgery. Confirm that the amount youre paying is consistent with other surgeons in the area.
Different offices offer different levels of aftercare. If your doctor provides extensive follow-up care, this may increase the overall cost of the surgery.
Likewise, technology will affect the final cost. Laser-assisted cataract surgery is typically more expensive than traditional surgery.
Is Laser Eye Surgery Covered By Medicare
LASIK is considered an elective surgery and is not covered by Medicare. In fact, Original Medicare doesnt cover routine eye care, such as eye exams, corrective eyeglasses, contact lenses and/or frames.
If you are enrolled in a Medicare Advantage plan, its possible your laser eye surgery will be covered. Medicare Advantage plans are required to provide the same benefits as Medicare Parts A and B, but many also offer additional benefits that sometimes include routine vision care and, in some instances, laser eye surgery.
LASIK may or may not be included with your benefits, so its best to check your plan or call your provider for confirmation.
CONSIDERING LASIK SURGERY? Find a LASIK surgeon in your area. Click the Services filter at top right of the doctor locator to find a LASIK specialist near you.
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What Is The Cost Of Cataract Surgery With Medicare
Typically, Medicare covers 80 percent of expenses for cataract surgery procedures and related expenses. These services include cataract removal, lens implants, and one set of eyeglasses or contacts following surgery.
If the cost of cataract surgery is $4,300, Medicare would pay about $3,440. Youd be responsible for the remaining amount. Also, you must first meet your annual deductible before your coverage kicks in.
Keep in mind that there may be additional costs that are not covered, such as if you opt for premium lenses. Medicare will usually cover monofocal IOLs, but you will have to pay the difference between the cost of these and premium lenses.
Confirm the total cost with your surgeon ahead of time, so you have a clear idea of exactly what you can expect to pay out of pocket.
Will Medicare Pay For Eye Exams
Medicare is meant to help you cover the cost of unexpected medical care. In a way, this is a form of catastrophic health insurance. Your coverage does not help you to stay healthy or prevent disease as much as deal with a medical crisis when it happens. This coverage can be of great help, but it also offers a limited form of protection.
Consider eye exams. A regular eye exam can help you uncover hidden eye health conditions that could impact your ability to see clearly. The conversation you have with a doctor during an exam can also help you understand what to do to protect eye health. Yearly exams are vital, but according to Medicare.gov, your Medicare Part B plan only covers a yearly exam for the condition diabetic retinopathy, and that coverage is only offered to people who have diabetes.
The Medicare Learning Network clarifies the issue by explaining that eye examinations your doctor might use to prescribe eyeglasses for you are not covered by Medicare. Since a test of your vision is often included in a yearly exam, it’s reasonable that Medicare would move to halt coverage for any kind of yearly exam. Since this is considered routine care, it would not be covered.
Doctors need to perform a thorough examination before clearing patients for LASIK surgery. During the exam, they measure the following:
- Tear production
- Eye pressure
- Eye symmetry
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What Does Medicare Pay For Vision Care
Original Medicare coverage excludes routine eye exams. The only coverage you will receive for vision though Medicare is to treat conditions like glaucoma, detached retinas, and cataracts.
Glaucoma is an eye disease that affects your optic nerve, resulting in vision loss. A detachment of a retina happens when the retina tears away from the underlying tissue.Certain health conditions or some form of trauma can lead to this severe injury. If a detached retina is not corrected with surgery, it can ultimately lead to permanent vision loss.
Cataracts cause a cloudy lens over your eye that can cause blurry eyesight. Certain chronic conditions like cataracts require surgery to repair the eye. In a situation like this, Original Medicare will extend coverage to the lens replacement surgery. The doctor will remove the existing cataract and replace it with a manufactured lens.
Medicare covers a pair of eyeglasses or contact lenses when you have replacement surgery. In this case, Medicare will also cover exams to diagnose vision issues you may be experiencing due to an eye ailment.
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Medicare will provide coverage if you have diabetes or if you are at a high risk for glaucoma. But, if you are not high-risk, paying out-of-pocket could be a requirement.
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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When Is Yag Laser Capsulotomy Necessary
YAG laser capsulotomy corrects complications from previous cataract surgery.
Cataracts cause the natural lens in your eye to become cloudy, reducing your visual acuity your ability to see clearly. Cataract surgery removes the damaged natural lens and replaces it with an artificial lens.
But the proteins that caused the original cataract may continue to grow in the repaired eye a complication called capsule clouding. It doesnt happen with every cataract patient and usually takes about one to two years for this complication to show up in those who do develop it.
YAG laser capsulotomy removes the protein buildup from the artificial lens. The procedure takes only about a minute or two, and the laser never touches the eye. Once completed, the procedure is usually not needed again.
How To Apply For Medicare Plans That Cover Cataract Surgery
Medicare plans are all fairly standard in coverage, says Emily Gang, the Denver, Colorado-based CEO of The Medicare Coach, an expert Medicare advisory service. The big difference comes from the type of Medigap or Medicare Advantage plan someone has. These plans determine how much you pay for your procedure.
During the annual open enrollment period, which runs from Oct. 15 to Dec. 7, you can select the Medicare Advantage plan that will work best for you. If you know youll need cataract surgery in the future, check to see which plan offers the most ideal coverage. It might be worth signing up, even if it has a higher monthly premium.
The best time to buy a Medigap plan is during your six-month Medigap open enrollment period, which starts when you sign up for Original Medicare.
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Will Medicare Continue Vision Coverage After Cataract Surgery
If you have any post-surgery complications or problems that are deemed medically necessary to address by a doctor, Medicare will cover those expenses. Any drops, antibiotics or other medication prescribed after your surgery would be covered by Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage.
Routine eye exams and/or corrective lenses are not covered.
Does Medicare Cover Cataract Surgery In 2022
The Part B portion of your plan provides Medicare coverage for cataract surgery. If inpatient treatment is a result of surgery, Part A might cover the treatment. Part B will pay for corrective lenses if you receive an intraocular lens to replace your eyes natural lens .
If you have switched to Medicare Advantage , your plan may offer vision coverage for your cataract concerns.
According to the National Eye Institute, more than half of Americans age 80 or older either have cataracts or have had cataract surgery. The government-sponsored institute estimates that cataract surgery improves eyesight in 9 of 10 cases, making it necessary to improve quality of life.
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Does Medicare Cover Laser Cataract Surgeryby William Goldstein On May 07 2019
Laser cataract surgery restores vision by removing a natural lens that has been clouded over by a cataract and replacing it with an intraocular lens, or IOL. Laser cataract surgery is a blade-free technique that further minimizes the already low risks of traditional cataract surgery.
Although cataracts can affect a person of any age, they are far more common among seniors. Because the majority of these patients are covered by Medicare insurance, it is common for them to wonder if Medicare covers laser cataract surgery. Detroit, MI eye surgeon William S. Goldstein and our staff help patients understand their insurance benefits so they know if they should expect any out-of-pocket costs for their procedure.
Will Medicare Continue Vision Care Coverage After Cataract Surgery
As part of your surgical services, you will have a follow-up appointment with your doctor after your surgery to make sure there are no complications. If you have complications or vision care needs related to your surgery that are medically necessary, Medicare will cover those services. You will be responsible for coinsurance charges.
After cataract surgery, Medicare Part B will pay for either one pair of eyeglasses with standard frames or one set of contact lenses from a supplier who is enrolled in Medicare. You pay 20% of the Medicare-approved charges. You have probably already met your Part B annual deductible for your cataract surgery.
If you have a Medigap plan, it will cover the Part B 20% coinsurance. Medicare Advantage plans will cover standard frames or one set of contact lenses as defined by Medicare, just like Part B does.
Regardless of which type of Medicare insurance plan you have, you will be responsible for the costs of any upgrades to your post-cataract surgery standard frames such as deluxe frames, tinting, or progressive lenses.
Your doctor may prescribe eye drops and/or antibiotics after cataract surgery. These would be covered by a Medicare drug plan or by your Medicare Advantage plan with drug coverage included. Copays and deductibles may apply.
Subsequent vision care that is medically necessary to treat disease or injury to the eye is covered by Medicare. Routine eye exams and corrective lenses are not.
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Will Medicare Cover Macular Degeneration
Age-related macular degeneration is the leading cause of vision loss in adults 50 and over. Medicare Part B will cover diagnostic tests and treatment for AMD, which may include drops or eye injections. As is the case with other covered services, youll still be responsible for 20% of the cost of your services or treatment after meeting your deductible, although a Medigap plan will cover some or all of those costs. Medicare Advantage will cover diagnostics and treatment for AMD as well, although as is the case with other services, the out-of-pocket costs will vary by plan.
How Much Does It Cost For Laser Eye Surgery
LASIK is an elective procedure and is not covered by Medicare, except under certain Medicare Advantage plans. If youre using supplemental insurance or paying out of pocket, laser eye surgery costs vary and depend on several factors:
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Level of correction. If you have extremely poor vision, you may pay a little more than other patients.
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Technology used. Surgeons using top-of-the-line equipment may charge more for laser eye surgery.
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Surgeons experience. Laser eye surgery from a seasoned surgeon tends to be more expensive due to their reputation and higher level of skill.
Depending on the factors above, LASIK surgery can range anywhere from $1,000 per eye to more than $3,000 per eye. In 2019, the average cost of LASIK surgery performed in the United States was $2,246 per eye, according to a report prepared for All About Vision by eye care industry analytics firm Market Scope.
Keep in mind that this is for each eye. The final cost will include the procedure, pre- and post-op care and a follow-up procedure for any fine-tuning.
Is LASIK right for you? An eye doctor will able to recommend the best procedure for your unique vision needs, and if you have a Medicare Advantage plan, look into coverage for elective eye surgeries.
Finally, to avoid any expensive surprises, ask for an itemized breakdown of the proposed LASIK procedure before committing to having laser eye surgery.
FOR MORE INFORMATION ABOUT LASIK: Find an eye doctor near you and schedule a consultation.
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