If Your Procedure Is In An Ambulatory Surgical Center
As of 2022, most cataract surgery in the United States is performed in an ambulatory surgical center. According to Medicares procedure lookup tool, the national average for the doctor and facility fee for routine cataract surgery are:
- Doctor Fee: $544
- Facility Fee: $1,062
- Total Fee: $1,606
If Medicare pays 80% of this amount, then they will cover $1,284. The remaining 20% is the responsibility of the patient, which amounts to $320.
Does Medicare Cover Dry Eyes And Allergies
Though having dry eyes wont necessarily impact your vision, it can be a painful condition that affects your quality of life. Medicare will generally cover an exam to diagnose the problem since its not considered routine, at which point youll be on the hook for 20% coinsurance after youve met your Part B. Your Part D plan might also cover medication to treat the condition, though in some cases, over-the-counter treatment will suffice. Youll get similar coverage with a Medicare Advantage plan, and Medigap can help with your out-of-pocket costs if you have Original Medicare.
Does Medicare Cover Other Costs That Come With Cataract Surgery
Original Medicare doesnt cover eyeglasses or contact lenses in most circumstances. But if you need them after cataract surgery, Medicare Part B pays for one pair of eyeglasses with basic frames or one set of contact lenses
Curb alcohol. Drinking to excess can raise the risk of cataracts.
Get regular eye exams. Detecting cataracts early can help people take preventive or other steps sooner.
Take care of overall health. People with other health problems, like diabetes, should follow their doctors orders for self care.
Eat healthy foods. Getting a variety of vitamins and nutrients from a regular diet can help keep eyes healthy.
Wear sunglasses. Choose shades that block ultraviolet B, or UVB, light, which may speed cataract development.
When Should I See A Doctor
Cataracts arent always noticeable in their early stages, which is why its best to schedule regular visits with your eye doctor for early detection.
But, if you do experience any of the following symptoms, its time to visit your doctor:
- Indistinct differences between colors
So, does Medicare pay for cataract surgery? Yes, once your deductible and co-payment are met, Medicare can cover the rest and keep your treatment affordable for you.
Does Medicare Cover Cataract Surgery
Cataracts are strongly linked to aging, and many people develop them in one or both eyes as they get older. In fact, according to the National Eye Institute, half of all Americans will either develop a cataract or have had cataract surgery by age 80.
Find affordable Medicare plans in your area
If you have Medicare coverage and your doctor determines that cataract surgery is medically necessary, Medicare covers the procedure to remove the cataract, as well as doctor services and related care following your surgery. You may be responsible for certain costs, including deductibles, copayments, and/or coinsurance.
Read on to learn more about cataracts and Medicare coverage of cataract surgery.
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Know Your Costs Before Surgery
Confirm all costs with your surgeon and your insurance provider prior to surgery. You can contact Medicare directly for information on the specifics of your coverage, particularly if you have a Medicare Advantage plan.
Ask to have all out-of-pocket costs detailed, so you know exactly what to expect going into surgery.
How Does Astigmatism Develop
Health insurance is designed to provide a buffer between medical expenses and your pocketbook. When you are struggling with a sudden health issue, such as a broken leg or a pinched nerve, you can get the care you need without worrying that the cost of that care will plunge you into poverty. When you have a longstanding issue, such as diabetes, insurance helps to ensure that your medical bills will not overwhelm your budget.
On the surface, astigmatism seems like a condition that should be covered by any medical insurance plan, including Medicare.
People with astigmatism have eyes that are irregularly shaped. That irregularity keeps light from focusing on the vision-sensing part of the eye, causing blurriness. The National Eye Institute reports that people with a slight astigmatism may not notice much vision impairment, but those with advanced cases may experience:
- Recurring headaches.
- Low night vision.
These symptoms can be serious, and they can interfere with your ability to tackle common tasks, such as driving. They can also make your life a little less pleasant, as you may be dealing with discomfort much of the time.
The American Optometric Association reports that the cause of astigmatism is unknown. While it can be present at birth, the severity of the condition can also increase or decrease with time.
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What Are The Costs Of Cataract Surgery
For people with original Medicare, the national average price of cataract surgery at an ambulatory surgical center is $1,606. The out-of-pocket cost can be as little as $320.
That said, several factors can affect your personal medical bill. These include:
Choice of facility: Surgery at an ambulatory surgical center typically costs hundreds of dollars less than at a hospital outpatient facility.
Type of surgery: There are two commonly used techniques for cataract surgery. Phacoemulsification uses a small incision extracapsular cataract extraction uses a larger one. A Medicare beneficiarys average ASC price is $361 for ECCE or $369 for phaco.
Type of artificial lens: Medicare only covers one type of IOL: the standard monofocal lens, which provides clear vision at one distance. But there are different types of IOLs. If you choose an advanced multifocal lens , it could cost you thousands of dollars out of pocket.
Potential post-surgery expenses: These can sometimes be costly. For instance, retinal detachment is a common complication. For surgery to repair it, a Medicare patients out-of-pocket cost can range from hundreds of dollars to more than $1,000. The total cost depends on the type of 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 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.
Does Medicare Pay For Anesthesia And Sedation
Under Part B, the medical insurance portion of Medicare, youre charged 20% coinsurance for anesthesia. With Part C, the coinsurance share varies by plan. Moderate sedation, where the person is awake, is considered a type of anesthesia and is likely to be covered as well.
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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.
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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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.
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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What Are My Options When It Comes To Premium Lens Implants
If you want to consider all your options, its important to know whats available to you. Herschel LASIK and Cataract Institute in Orlando offers the following premium intraocular lens options:
Toric IOLs are unique because they are the only IOL thats specifically designed for patients with astigmatism. Astigmatism occurs when the cornea is irregularly curved.
When this happens, your vision will be distorted and blurry. Its also common to have other refractive errors like nearsightedness and farsightedness when you have astigmatism.
Toric IOLs correct astigmatism and provide patients with clear vision after cataract surgery.
If the concept of needing glasses to see at more than one distance wasnt appealing, multifocal IOLs may sound better. These IOLs restore a full range of vision in both eyes.
This includes near vision, intermediate vision, and distance vision. Multifocal IOLs work because they contain rings with different magnifications which enable a wider range of clear vision.
These rings help the brain pick the right focus automatically. This is something that patients never have to think about since it happens automatically.
There is some adjustment that may be necessary, but most patients get used to their multifocal IOLs quickly.
Another kind of premium lens to consider is an aspheric IOL. With aspheric IOLs, this lens is the closest to the shape of the natural lens.
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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Cataract Surgery Is Considered Medically Necessary
Cataracts are a disease of the lens in the eye, which is the organ behind the pupil that refracts light onto the retina, so the brain can process images of the world around you. There are several diseases that can affect the lens and therefore impact vision. Cataracts are one of the conditions that can lead to blindness over time.
This condition starts when proteins in the lens break down, leading to blurring or clouding of your vision. Damaged proteins will clump together in specific formations leading to loss of sight. You may also experience double vision, yellowing or fading vision, or cloudy spots in your line of sight.
Although many people develop cataracts because of an injury, disease, or congenital defect, most cataracts occur due to age. Everyones vision changes as they get older, but over the age of 40, cataracts become increasingly likely. After middle age, you may develop cataracts in one or both eyes.
The majority of cataracts that begin in middle age are small and do not affect your vision for many years. Most people do not experience serious problems driving, seeing objects, or performing activities until they are in their 60s.
Since cataracts affect older and elderly adults, it is important to know how insurance, especially Medicare, covers this condition. Although the federal health insurance program does not cover most vision issues, cataract removal is covered.
Understand The Relevant Rulings By Cms
John McInnes, MD, JD
Premium IOL is an unofficial term that refers to IOLs that CMS has designated as presbyopia-correcting, astigmatism-correcting, or a combination of the two. IOLs that are not premium are generally referred to as conventional IOLs these are primarily monofocal IOLs that provide distance vision but not near vision or astigmatism correction. Through Administrator Rulings CMS-05-01 and CMS-1536-R, CMS established that cataract surgery that is performed on a Medicare beneficiary and that includes the implantation of a premium IOL is a partially covered service under Medicare. This means that all items and services consistent with cataract surgery and the implantation of a conventional IOL are covered by Medicare and that the premium IOL and the services attributable to the premium IOL are not covered by Medicare and are therefore paid for by the patient.
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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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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