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.
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What Is The Medicare
The Medicare-approved amount refers to the amount the supplier of the glasses receives, which might be less than the amount the supplier charges. The patient is responsible for paying the difference if a disparity exists between the Medicare-approved amount and the suppliers charge.
The patient has to pay the costs of any non-covered add-ons, and only eyeglasses from a Medicare-enrolled supplier are eligible for coverage. Besides extras, the patient must pay the surgery cost, the Medicare Part B deductible of $233 in 2022, the monthly premium, and 20% of the Medicare-approved amount.²
Medicare And 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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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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How Do Progressive Lenses Work
So, how do progressive glasses work? Progressive lenses allow you to see at all distances with one pair of glasses. They start with your distance prescriptions at the top of the lens and increase as you move toward the bottom of the lens. You can move your head position to allow you to focus through different areas of the lens.
Move your head upwards to see something in the distance, and hold it straight for intermediate or arms length vision and down for near vision for objects that are close up. Apart from the aesthetic improvement of the lens without the line segments, progressive lenses avoid the visual discontinuity or image-jump when your eyes shift from one zone to the other in non-progressive multifocals.
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Does Medicare Cover Eye Prostheses
Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defect, trauma or surgical removal. Medicare covers polishing and of the artificial eye, and typically covers replacement every five years.
You pay 20% of Medicare-approved amounts after the Part B deductible is applied.
Does Medicare Cover Vision And Glasses
Original Medicare does not cover routine vision exams or glasses, but Part B helps cover certain vision-related services if you have eye disease or injury.
Medicare Advantage Plans, an alternative to Original Medicare, provide the same coverage as Part B, plus more. Most MA plans offer some coverage for routine eye exams and corrective lenses.
Part B vision care coverage is limited to medically necessary treatment for your eye problems. Some of the eye conditions covered by Part B may be a common and normal part of aging and are considered to be Medicare-covered services. MA plans include all Medicare-covered services plus some non-covered Medicare services, such as routine eye exams and financial allowances for corrective lenses.
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Questions To Ask Your Eye Doctor Before Cataract Surgery
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Do they accept Medicare?
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What is the Medicare code for the specific procedure you plan to have?
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Where will the procedure be performed: a surgical center or a hospital?
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Will this be an inpatient or outpatient surgery?
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Will you require any prescription medications before or after the surgery? If so, which ones?
Your eye surgeon should be willing to discuss with you the different options available and the associated costs not covered by Medicare. From this consultation, you can decide what you do and dont want done during your cataract surgery, based on your priorities and budget.
For example, Medicare Part B covers basic cataract surgery and intraocular lenses , but it will not cover the added cost of certain premium IOLs or procedures. However, choosing a premium IOL or an additional procedure, such as limbal relaxing incisions to correct astigmatism, may significantly improve satisfaction with your vision after surgery and be worth the added expense.
The pre-surgery exam is an opportunity for you and your cataract surgeon to gain a shared understanding of whats to be expected during and after your cataract surgery.
And dont hesitate to ask questions about costs, insurance, etc. If your surgeon is unsure about a particular Medicare question, reach out to a Medicare representative in your area to get an informed answer.
Page published on Monday, January 14, 2019
Page updated on Thursday, September 17, 2020
Does Medicare Cover Eye Surgery
Although Medicare doesnt cover vision, hearing, or dental procedures, there are certain exceptions. For instance, if you require eye surgery or have a chronic eye condition that puts you at high risk, Medicare can cover cataract surgery or exams for high-risk patients with diabetes.
Medicare can cover cataract surgery with the exception that its done using traditional surgical techniques or lasers. Medicare would be able to cover 80 percent of the cost of medically necessary cataract surgery after the deductible is met. Additionally, Medicare Part B can help pay for corrective lenses after youve undergone cataract surgery to implant an intraocular lens. If the procedure is deemed medically necessary, the corrective lenses would be covered by Medicare.
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What 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.
Cataract Surgery Cost And Coverage With Medicare
Medicare covers both types of cataract surgery equally. Your eye doctor will help you determine which is better for you during an eye exam.
The different plans of Medicare come into play at various points of your cataract surgery journey and provide coverage for different expenses, while working together to help you walk away from your procedure with the lowest cost possible.
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Medicares Coverage Of Cataract Surgery And Other Vision Benefits
Most people are surprised when they turn 65 to find out that Medicare has fairly limited benefits for vision services. After all, our vision often worsens as we age, so we generally need more vision care as an older adult.
While Medicare doesnt cover routine vision services, it does offer benefits for a variety of injuries or illnesses related to optic health.
Heres what you can expect for vision coverage once you enroll in Medicare.
How Much Is Cataract Surgery With Insurance
As a general example, a standard cataract surgery in a clinic or surgery center may cost about $3,500. A patient with Medicare insurance coverage will be responsible for $700 . The total out-of-pocket cost will also include the deductible amount, which depends on the patientâs specific insurance plan.
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Does Medicare Cover Other Costs Associated With Cataract Surgery
Though Medicare covers 80% of most of the costs of cataract surgery involving intraocular lens implants, more advanced treatments may require you to cover a greater percentage, or even all of the cost.
Medicare will cover one pair of glasses after your surgery, though things like updated frames, additional pairs of contact lenses, or other items associated with the treatment such as eye drops likely wont be covered. Its also important that you speak to your healthcare provider about what specifically is, and is not, covered under your plan to avoid unexpected costs.
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.
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Does Medicare Cover Specialized Eye Treatments
Medicares eye health coverage varies based on whether or not you have certain conditions. For example, Medicare Part B covers eye exams for diabetic retinopathy once a year if you have diabetes.
If youre at high risk for glaucoma, Medicare Part B will cover tests every 12 months. Certain diagnostic tests and treatment for age-related macular degeneration also are covered.
With Original Medicare, Part B deductibles will still apply and you will pay 20% of the Medicare-approved amount for these services. In a hospital outpatient setting, you would pay a copay.
LOOKING FOR AN EYE DOCTOR WHO ACCEPTS MEDICARE? Book an appointment with a local eye doctor near you.
Page published on Saturday, February 29, 2020
Page updated on Wednesday, March 16, 2022
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Does Medicare Pay For Glasses After Cataract Surgery
Yes, Medicare will cover one pair of glasses with standard frames or one set of contacts prescribed by your doctor after your cataract surgery is complete. These glasses or contacts must be procured through a Medicare-approved supplier.
To avoid any sticker shock with your new glasses, ask your doctor or health care provider for a list of Medicare-approved frames before making a selection.
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Does Medicare Cover Eye Exams 2022 Medicare Vision Coverage
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While it doesnt offer the comprehensive coverage of vision insurance, Medicare can provide coverage for medically necessary vision care, often for patients with certain health conditions like diabetes or glaucoma.
In this article, Ill discuss what type of eye exams Medicare covers, cataract surgery coverage, and how to find eye doctors that accept Medicare.
FYI: Often, vision coverage is pretty affordable. Read my picks for dental and vision insurance for seniors to learn more.
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Why Is My Vision Still Blurry After Cataract Surgery
Sometimes blurry vision is caused by PCO, a fairly common complication that can occur weeks, months or years after cataract surgery. It happens when the lens capsule, the membrane that holds your new, intraocular lens in place, becomes hazy or wrinkled and starts to cloud vision.
Does Medicare Cover Vision Care
Generally, Medicare does not cover vision care. However, Medicare does cover medically necessary services. What does that mean? Cataract surgery that is deemed by a physician as medically needed, falls into this category. With Original Medicare, cataract surgery services are typically covered under your Part B portion of Medicare.
Different parts of Medicare cover different areas of medical expenses. If you need a refresher on the parts of Medicare, be sure to check out our video that explains it all.
As a reminder, Medicare Part B insurance covers outpatient services. If you have a Medicare Advantage plan, they should cover the same services as Original Medicare but may have different costs and conditions. We know, its confusing! Therefore, if you are on a Medicare Advantage plan, it is very important to contact your plan representative for your specific costs and coverage of cataract surgery. They will know exactly what is covered and what isnt.
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Cataract Treatment Begins With A Consultation
Since costs vary significantly, you should start by booking a consultation with an ophthalmologist. He or she can give you an estimate based on your needs and treatment options.
If you have a Medicare Advantage plan, call your insurance provider to confirm how it covers the type of treatment youre looking for and about any coverage rules, such as prior authorization or a network.
If you have a Medigap policy, your coverage will pair with Medicare automatically.
Although Medicare and cataract surgery coverage may seem complicated, millions of seniors undergo successful procedures every year. The procedure itself is simple, low-risk, and can permanently improve your vision.
Cataract surgery doesnt have to be expensive either. There are a few ways to lower your out-of-pocket costs. These include choosing standard surgery, buying a Medicare Supplement plan, or in some cases, switching to Medicare Advantage.
As you start your journey toward better vision, ask questions. Your doctor and insurance provider can help you decide which options meet your needs and budget.
What Is The Best Medicare Plan For Cataract Surgery
Several Medicare Advantage plans cover all costs for cataract surgery, though youll need to find a physician, hospital or surgery center that is contracted with your specific Advantage plan. To keep costs down, you may also want to seek an Advantage plan that has low copays and includes vision insurance.
Most doctors and hospitals are contracted with Original Medicare, though not all are contracted with Medicare Advantage. Youll also need to pay for 20% of your procedures total cost.
You might consider a Medicare Supplement plan to bolster your basic Part B coverage. Plan G, for example, covers all cataract surgery costs, save for your Part B deductible and Medigap premium payments.
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