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How Much Of Cataract Surgery Does Medicare Cover

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Does Medicare Cover Cataract Surgery?

Original Medicare does not cover routine eye exams, and it will only cover prescription lenses immediately after a cataract surgery procedure. A Medicare Advantage plan may include vision insurance to cover routine eye exams and prescription lenses. Some Medicare Supplement companies include an add-on vision discount program to help you save on eye exam costs.

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Treating Cataracts With 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.

What Does Medicare Cover After Cataract Surgery

After the surgery, Medicare will cover one pair of glasses or contact lenses. This is an exception to Medicare coverage rules, which normally exclude eyeglasses from coverage.

Important to note:If on Original Medicare, you should obtain your glasses or contact lenses from a supplier that accepts assignment to pay the least for your item. You will pay 20% of the Medicare approved amount for the glasses or contact lenses. If on a Medicare Advantage plan, contact you plan representative to learn where you should get your glasses or contact lenses.

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Does Medicare Cover Glasses Or Contacts

For the most part, Medicare does not cover routine vision care, glasses, or contact lenses. However, Medicare can make an exception

You may be wondering, How much does Medicare pay for glasses after cataract surgery? After your surgery, Medicare will cover 80% of the costs for prescription glasses or contacts, but you must purchase them through a provider who accepts Medicare assignment.

You will be responsible for the remaining 20%. Some beneficiaries have trouble getting Medicare to cover the pair of glasses or contacts.

If you are denied coverage, you can appeal the decision and request that they are covered. If you already paid for them out of your own pocket, you can request reimbursement.

You and your health provider can write a letter to add to your appeal, just be sure to state that you had met the requirements for cataract surgery, so your glasses or contacts must be covered.

Will Medicare Continue Vision Care Coverage After Cataract Surgery

How Much Does Medicare Pay For Cataract Surgery In 2021

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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How Do I Estimate My Cost For Cataract Surgery

Its easy to determine your costs for cataract surgery ifyou have a Medicare Supplement plan. You can do so by performing the followingsteps:

  • Review your plan details, looking specificallyfor coverage for deductibles, coinsurance, and excess charges
  • Ensure that your doctor and all related careproviders accept Medicare
  • Contact your Part D prescription provider todetermine the costs of any antibiotics or painkillers that youll be prescribed

If you have Medicare alone, youll need to:

  • Ask for a breakdown of whats charged for eachstep of the procedure
  • Find out which parts of the procedure arecovered 100 percent and subtract that amount from the total cost of theoperation
  • Plan on paying 20 percent of the amount that isnot completely covered
  • Determine your prescription medication costs
  • Determine copayment in advance for after surgerycare and doctor follow-up

If you have a Medicare Advantage plan, youll need tocontact your carrier directly. These plans can vary widely, so ask what stepsyou need to take to determine your costs.

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.

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Which Medicare Plans Offer Cataract Surgery Coverage

  • Original Medicare, which includes Part A and Part B , offers cataract surgery coverage. This procedure most often takes place in an outpatient setting, such as an ambulatory surgery center, or a hospital outpatient department, both of which fall under Part B benefits. Part A coverage would only apply if the surgery is done in a hospital.
  • Medicare Supplement Insurance plans help cover the out-of-pocket costs you incur when you access your Original Medicare benefits. For instance, if your cataract surgery takes place in an outpatient setting , Part B will pay for 80% of approved Medicare charges after you satisfy your annual deductible. Most Medigap plans will cover the other 20%. You will still be responsible for the Part B annual deductible and your Medigap monthly premium.
  • Medicare Advantage plans, as an alternative to Original Medicare, also cover cataract surgery. MA plans provide the same benefits as Original Medicare does, so if a service is covered under Original Medicare, in this case, cataract surgery, it is also covered under a MA plan.

Both MA plans and Medigap plans are approved by Medicare and are offered by private insurance companies. You cannot have both at the same time.

With Original Medicare, you are responsible for 20% of the Medicare-approved charges after you satisfy your annual Part B deductible . Part B covers 80%.

Medicare Advantage And Cataract Surgery

Does Medicare Cover Cataract Surgery

Medicare Advantage covers cataract surgery. Your private health insurance provider may cover the full cost of cataract surgery on the condition that you pay outpatient surgery copayments or a deductible. Contact your Medicare Advantage plan provider to see which costs are covered and what youll have to pay out of pocket depending on your plan.

To learn more about this type of coverage, read my guide Medicare Advantage vs. Medigap.

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How Do You Know If You Need Cataract Surgery

Talk to your doctor if you experience any changes to your vision such as cloudiness or halos around lights. According to Harvard University, you should have an eye exam every year if youre 65 or older.

Dr. Laura Fine, an ophthalmologist with Massachusetts General Hospital, says you dont need cataract surgery until you think you need to see better.

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Does Medicare Cover Laser Cataract Surgery

The short answer to this question is yes.

Medicare will cover your cataract surgery, regardless of the method used. So, whether the surgery is performed using a laser or a more traditional technique, the only thing that matters regarding your coverage is which procedures are performed. This means that if youre going to undergo a laser cataract surgery, you will still receive the same coverage.

Additional Questions To Ask Your Doctor Before Cataract Surgery

How Much Does Medicare Pay For Laser 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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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.

How Much Does Medicare Cover For Cataract Surgery

Medicare specifically covers these parts of cataract surgery services:

  • Removal of the cataract
  • One set of prescription eyeglasses or one set of contact lenses after the surgery

Medicare covers basic lens implants only. Medicare does not cover more advanced implants.

Important to note:If your provider recommends more advanced lens implants, you may have to pay some or all of the cost. Talk with your health care provider before surgery to understand which costs you will be responsible for, and which costs will be paid by Original Medicare or your Medicare Advantage plan.

Whether you have Original Medicare or Medicare Advantage, here is a breakdown of Medicare billing and coverage for the costs associated with cataract surgery:

  • Medicare Part B would cover your outpatient surgery center costs. This includes doctors fees and other expenses associated with outpatient surgery.
  • Once you meet your Medicare Part B deductible, Medicare pays 80% of allowable charges.
  • Medicare Part A would cover your hospital stay if the cataract surgery takes place in a hospital rather than an outpatient facility. The Medicare Part A deductible would need to be paid if your cataract surgery requires an inpatient stay.
  • Medicare Part D would cover any drops and other medications you are prescribed before and after the cataract surgery.
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    The Cost Of Cataract Surgery

    Cataract surgery can be expensive, and the total cost varies depending on which type of lens you choose. Toric lenses cost around $1,500 per eye, while specialty lenses can cost up to $3,000 each.

    Typically, insurance covers at least some of the costs of the procedure, though many people still have some out-of-pocket expenses.

    For adults with Medicare, rather than Medicaid, cataract surgery that is done with traditional surgical techniques or lasers is covered. Additionally, Medicare Part B covers some of the cost of corrective lenses, such as eyeglasses or contact lenses, following the implantation of an intraocular lens during cataract surgery.

    If you are insured by Medicare, you are responsible for 20 percent of the cost approved by Medicare for new corrective lenses following cataract surgery as well as the Part B deductible. Upgraded frames or lenses come at an additional cost to you.

    Some qualifying individuals are insured by both Medicare and Medicaid. Medicare is used as the initial form of coverage and then Medicaid can be used to fill gaps in coverage. Supplement insurance plans can also be used to cover gaps in your primary health insurance plan, whether you have Medicaid, Medicare, or a private insurance health plan.

    Eyeglasses And Contacts After Cataract Surgery

    Medicare Explained: Does Medicare Cover Cataract Surgery and Glasses?

    If you undergo standard cataract surgery, you may need to continue using glasses or contacts.

    Medicare Part B will cover 80% of the cost of conventional contacts or eyeglasses after your surgery. If you pick more expensive frames, youll need to pay the difference. Be sure to ask your optometrist about what Medicare will cover. Your out-of-pocket cost can vary depending on the lens selected.

    Before you buy, make sure your supplier has a Medicare supplier number. Medicare wont pay your claim without one. Also, tell your optometrist to send the bill to Medicare.

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    Breaking Down The Medicare Costs For Cataract Surgery

    Medicare Part B covers cataract surgery so long as it is performed using traditional surgical techniques . Cataract surgeries are usually performed on an outpatient basis, meaning a hospital stay is usually not necessary.

    While Medicare pays most of the costs for standard cataract surgery that implants monofocal lenses, Medicare doesnt cover additional costs, such as the use of premium IOLs or laser cataract surgery.

    Medicare will pay around 80% of the Medicare-approved amount of the surgical procedure. The Medicare-approved amount refers to the total cost of a doctor or supplier is paid. This means patients are expected to pay the remaining 20%.

    Note: Learn more about Medicare cataract surgery costs at this resource.

    Can Medisave Be Used For Cataract Surgery

    While it is a day surgery procedure, cataract surgery is Medisave claimable, subject to the approved surgical limit. In addition, if you have an Integrated Shield Plan, you can claim part or all of your cataract surgery cost, depending on your private insurance coverage, for both private and public hospitals.

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