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Does Medicare Pay For Cataract Eye Surgery

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Financing Your Cataract Surgery

Does Medicare Pay for Cataract Surgery?

Typically, cataract surgery is covered by insurance and Medicare. However, in the event that your procedure is not fully covered, or if you elect to choose an upgraded lens option as part of your treatment plan, NVISION® offers financing options to ensure that you are not inhibited by cost. Read on to learn more about CareCredit® and see how cataract surgery can be affordable.

How Do I Qualify

If youre 65-or older and your doctor has determined surgery for your cataracts to be medically necessary, Medicare will typically cover 80% of your expenses including post-surgery eyeglasses or contacts.

While coverage often varies from region-to-region and between local carriers, so as long as your doctor accepts Medicare as payment, youre covered for cataract surgery.

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.

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How Can You Know How Much Cataract Surgery Will Cost Before You Have It Done

Youll need information from your eye doctor and Medicare to figure out how much youll have to spend out of pocket for cataract surgery.

Your doctor may be able to tell you what much of your operation is covered by insurance and how much youll have to pay out of pocket.

Your private insurance provider can inform you of your projected out-of-pocket payments if you have acquired a Medicare Advantage or other plan via them.

Medicare And Cataract Surgery

Does Medicare Cover All the Costs of Cataract Surgery?

Medicare typically covers cataract surgery if a physician deems it medically necessary. Since Original Medicare consists of both Medicare Parts A and B, a majority of the coverage will come from Part B as long as the deductible is met.

Under Part B or outpatient insurance, Medicare will pay 80 percent of the cost of cataract surgery as well as the cost of eyeglasses or contact lenses post-surgery. You will owe 20 percent of the Medicare-approved amount.

If you have a Medicare Advantage plan, your private carrier will pay for your medical costs instead of Medicare. Private insurers must offer benefits as good as Medicare, but the benefits are not standardized. Each plan has its own summary of benefits, so youll need to contact your carrier directly to find out how much it will cover and how much youll have to spend out of pocket.

If you have a Medigap plan, the 20 percent coinsurance under Part B will be covered. Medigap will always pay the leftover coinsurance under Part B as long as Medicare pays its portion.

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Eye Exams For Individuals With Glaucoma And Diabetes

If youre at risk for glaucoma or diabetes, Medicare Part B can cover annual eye exams once every 12 months. For instance, if you use Medicare Part B for glaucoma eye exams, 80 percent of the exam will be covered. However, youd still be responsible for paying the remaining 20 percent of the Medicare-approved amount after youve met your Part B deductible.

Medicare Requirements For Cataract Surgery

Your vision must be 20/40 or worse to qualify for surgery. Your doctor will need to document that your vision is at this level or lower.

You also need to have difficulty completing daily living activities like reading, sewing, watching television, or driving.

Its important to remember that the cloudiness in your eye is not directly correlated to the severeness of your cataracts. If you are unsure of your vision level or whether or not you qualify, visit your eye doctor.

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The Details Regarding The Cost Of 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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Want More Information About Medicare Coverage For Cataract Surgery

â? Does Medicare Cover Cataract Surgery? Should You Wait?

As you can tell, you have several choices if you need cataract surgery and are concerned about coverage. If youd like help finding a Medicare Advantage or Medicare Supplement plan that may help with cataract surgery costs, I am happy to help you understand your options. If youd prefer a phone call or email with personalized information, click the corresponding link below to do that. The Compare Plans button will show you information about plan options you may be eligible for.

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Types Of Cataract Surgery

There are multiple kinds of cataract surgery:

  • Phacoemulsification cataract surgery: This form of cataract surgery is the most common. During surgery, the ophthalmologist removes the cloudy cataract lens and replaces it with a foldable intraocular lens implant, also known as an IOL.
  • Extracapsular cataract surgery: With extracapsular cataract surgery, the doctor removes the natural eye lens but leaves a portion of the posterior lens in place. By doing so, the doctor can implant an artificial IOL without having to make major incisions.
  • Intracapsular cataract surgery: Intracapsular cataract surgery is one of the least common forms of cataract correction. With this approach, the eye lens and entire eye lens capsule are removed and replaced with an IOL. This form of surgery has a higher risk of complications than other types.
  • Laser cataract surgery: Instead of hand-held tools, laser cataract surgery uses lasers to make incisions in the eye lens. It is more advanced and precise than other forms of cataract surgery, but its also more expensive.

Now that you know more about cataract surgery options, you can talk with a licensed Medicare professional at and figure out which Medicare plan is right for you and your health care needs.

Does Medicare Cover Eye Exams

If you want to run into your local vision center for a simple exam to get glasses, Medicare wont cover. Youll be 100% responsible for the cost of your prescription eyewear, as well as your routine exam.

If youre in the market for preventive screenings and tests to check for glaucoma or macular degeneration, youre in luck. Medicare will cover preventive screenings to help keep the health of your eyes in check. Not only will Medicare cover the exams for macular degeneration, but theyll include any doctor visits to treat the disease.

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Insurers Cover Most Costs But Be Sure You Understand Your Options

As a medically necessary procedure, Cataract Surgery is covered by Medicare, which pays a portion, if not all of the costs, including the surgeons and facility fees, the cost of a standard monofocal lens implant, and required follow up care.

You may be responsible for a co-pay or a deductible for pre-surgery office examinations, consultation and measurements for your cataract surgery. Patients are also responsible for their copay or deductible for the actual surgery itself.

You should speak in-depth with your surgeons billing office and your insurance provider or Medicare representative before having cataract surgery, to help you understand exactly how much is covered and how much you ultimately may need to pay out-of-pocket.

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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.

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How To Check My Coverage

In order to find out if your Medicaid plan provides coverage for vision services, you need to contact your state Medicaid agency. This agency can help you with:

  • Medicaid eligibility.
  • Liens and third-party liability.
  • Provider enrollment.
  • Lost Medicaid card or replacement.
  • Finding a Medicaid provider.
  • The status of a Medicaid application.

Because services vary from state to state, you need to speak with your states agency in order to get accurate information about your coverage.

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.

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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

Treating Cataracts With Surgery

Does Medicare Cover Cataract Surgery

Doctors will often recommend surgery to treat cataracts. If you have cataracts in both eyes, the surgery is usually performed on one eye at a time. However, the correction of cataracts in one eye may be enough to improve your vision, and your doctor and you may decide to opt to cancel the surgery on your second eye.

Cataracts surgery is usually done on an outpatient basis, and it essentially involves replacing the natural lens in the affected eye with an artificial lens. The surgery has become fairly common: many people have cataracts removed every year, and most surgeries are successful and free of complications. But you should always discuss the risks of such surgeries with your medical provider.

Cataract surgery is extremely popular because it usually provides a lasting solution to a common problem. The surgery removes the entire lens and replaces it with an artificial lens that cannot develop a new cataract.

Your vision will likely continue to improve in the weeks following your cataracts surgery. In some cases, people still require reading glasses even after the cataracts are removed, which will be determined by your eye doctor.

In certain cases, even if you have cataracts, you may not need surgery at all. Ask your doctor about other options to treat cataracts. Medicare may cover non-surgical medical treatments for cataracts depending on necessity and type.

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What Coverage Exclusions Might Apply

Medicare covers traditional and laser cataract surgery, but has not yet begun paying for New Technology Intraocular Lenses . For example, some toric lenses, designed to correct astigmatism, may not be fully covered. Discuss with your eye doctor whether it makes sense for you to pay more for the potentially greater improvement in vision.

Is Lasik Covered By Medicare

Unfortunately, Medicare won’t cover the costs of LASIK or any similar laser eye surgery, but some Medicare Advantage plans might.

What is LASIK? If you wear prescription glasses or contact lenses, youve probably considered laser eye surgery as a way to see clearly without specs or contacts. LASIK improves vision for patients with nearsightedness, farsightedness or astigmatism, often providing immediate and long-term improvement with minimal pain or discomfort.

Lets review why LASIK isnt included in your Medicare benefits, how this procedure differs from cataract surgery and the potential costs involved if you elect to have laser eye surgery.

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Does Medicare Cover Laser Eye Surgery For Cataracts

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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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Does Medicare Advantage Cover Cataract Surgery

Cataract surgery options made clear

Medicare Advantage, also known as Part C, offers you a way to receive your Medicare benefits through a private insurance company. Because of this, the plans tend to vary a lot throughout the country, both in price and in coverage. However, many Part C plans will cover cataract surgery. As some plans may cover more than Original Medicare, it is worthwhile to research each in detail if you already have a Part C plan.

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Cataract Surgery And Medicare Advantage

Medicare Advantage plans are required to cover, at a minimum, the same as Original Medicare. However, MA plans offer several additional benefits like prescription drug coverage, hearing and dental coverage, group fitness classes like SilverSneakers, and additional vision coverage.

Benefits will vary by plan but can include routine eye exams, eyeglasses, contacts, frames, and fittings. These benefits allow you to check your vision each year and update your prescription, lenses, and frames as needed.

If you are only enrolled in Original Medicare, you will need to pay for these expenses out of your own pocket.

Find Cheap Medicare Plans In Your Area

Cataract surgery is covered by Medicare, and how much you’ll pay for the surgery will depend on which type of Medicare plan you have and the plan’s 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.

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Will Medicare Cover My Cataract Surgery

Yes, Medicare will cover your cataract removal surgery, but only if your doctor considered the procedure medically necessary. In regards to cataract surgery coverage, Medicare will cover the pre-exam surgery, the surgery itself, and the surgical anesthesia.

Patients who undergo medically necessary cataract removal will need to pay 20 percent of the Medicare co-insurance for the procedure as well as their Medicare deductible.

If cataract removal is not medically necessary, then Medicare will not cover the procedure.

Medicaid & Cataract Surgery

Medicare – Will it Pay For Cataract Surgery?

More than 50 percent of Americans over the age of 80 have cataracts or have had cataract surgery. This very common procedure is used to restore vision that has been impacted by cloudy lenses. It is a safe and highly effective surgery to correct vision problems due to cataracts.

Medicaid is an insurance program that is available to qualifying low-income individuals, elderly adults, children, pregnant women, and people with disabilities. It is a federal program that is administered by each state. It is funded jointly by state governments and the federal government.

Each state Medicaid program must meet certain federal requirements, but there is also room for states to choose optional services to cover. Optometry services, including eyeglasses, are an optional service.

Children covered by Medicaid are covered for a vision screening at each well-child checkup. If any conditions that warrant further testing or treatment are discovered, the costs of those additional procedures are also covered.

For adults to receive coverage for vision services, the services must be deemed medically necessary. Medical necessity is determined by state.

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Cataract Coverage With Medicare Advantage Plans

A Medicare Advantage plan, or Medicare Part C, is an insurance plan that combines all your Original Medicare coverage together into a single health insurance plan. These plans are managed and administered by private insurance companies, and many of these plans provide additional benefits beyond Original Medicare coverage. The plans must provide at least the same minimum level of coverage as Original Medicare. However, many plans provide additional benefits, like vision coverage, dental coverage, gym memberships, and other benefits.

Since Medicare Part B covers cataract surgery, your Medicare Advantage plan must also provide coverage for the surgery. Most of these healthcare plans provide benefits well beyond just cataract surgery. Many of the plans also include vision coverage as well as prescription drug coverage. These additional benefits might help cover your out-of-pocket costs related to non-surgical treatment options. Your Advantage plan might cover routine visits to your eye doctor, corrective lenses, a set of contact lenses, eye drops, and other things not covered by Medicare. You will likely still incur additional costs, such as copays or coinsurance amounts. You should obtain your plan details from your insurance provider to determine the specifics of your coverage.

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