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What Does Medicare Pay On Cataract Surgery

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Cataract Surgery And Medicare Supplements

How much does cataract surgery cost?

Medicare Supplements work alongside Original Medicare and are a great way to add financial benefits to your current coverage. They can help cover your 20% coinsurance and your Medicare Part B deductible.

Plan F is currently the only plan that covers your Part B deductible.

However, Plan F was discontinued in 2020. If you enrolled in it before the start of 2020 you are locked into this plan and will maintain coverage. If you are interested in enrolling in Medicare Supplement Plans, fill out this form or give us a call at 1-855-783-1189 .

The Cost Of Cataract Surgery Can Be Rough

While the cost of cataract surgery may be covered by Medicare, it’s all of the additional treatment that can bury you. If you’re not prepared, you’ll pay hundreds just to get the lenses you need to see after your surgery.

Follow our guide step by step to take care of yourself following your cataract surgery.

Medicare Coverage Of Post

You may already know this, but its worth emphasizing: Medicare does not cover refractions, eyeglasses, or contact lenses for beneficiaries. The exception is for post-cataract surgery or in cases when surgery results in the removal of the eyes natural lens.

Whether the patient has an Intraocular Cataract Lens implant determines the extent of Medicare glasses coverage. CMS states that One pair of conventional eyeglasses or conventional contact lenses furnished after each cataract surgery with insertion of an IOL is covered, according to the Medicare Benefit Policy Manual, Ch. 15. Covered Medical and Other Health Services,§ 120.B.3.

Given this directive, it would appear a patient who has had cataract surgery on one eye and is waiting to have the second eye done could qualify for post-cataract eyewear after the first surgery and an additional pair of Medicare-covered glasses after the second.

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Does Medicare Cover Vision Cataract Surgery Or Glasses

Original Medicare, known as Medicare Part A and Part B, covers quite a few medical services. From preventive care to life-saving procedures, Medicare can help out. But unfortunately, this is not always the case when it comes to vision benefits.

Weve compiled a list of the most frequently asked questions about vision benefits provided by Medicare Part A and Part B.

Medicare And Cataracts: Taking The Fear Out Of Removing Cataracts

Will Medicare Help Pay For Cataract Surgery?

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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What Is The Recovery Time After Cataract Surgery

Your doctor may prescribe eyedrops or other medication to prevent infection, reduce inflammation and control eye pressure. Sometimes, these medications can be injected into the eye at the time of surgery. After a couple of days, most of the discomfort should disappear. Often, complete healing occurs within eight weeks.

Abns Are Not A Front Desk Thing:

The ABN is a form that requires special consultation and should be treated as such. The ABN should not be filled out at the front desk, which is where its usually done, says Holt. ABNs should be completed either in the exam lane or in the optical with the optician. That is who has the knowledge of whats going on with that patient for that charge, she advises.

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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.

Will Medicare Continue Vision Care Coverage After Cataract Surgery

Medicare – Will it Pay For 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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What Is A Cataract

A cataract is a clouding of the lens in your eye. Early cataracts are small and do not affect vision, though they may be detected in an eye exam.

As a cataract grows over time, it clouds more of the eye lens and affects vision. Vision changes caused by cataracts may include:

  • Bright glare from headlights, lamps, or sunlight
  • Difficulty seeing at night

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How Much Is Cataract Surgery With Insurance

Regarding insurance coverage, the brief answer is that yes, cataract surgery is covered by Medicare and commercial insurance. The quick answer is it depends regarding cost, but about $3000 per eye is a reasonable ballpark figure for everything including the surgeon fee, facility fee, and anesthesia fee.

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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%.

What Should Beneficiaries Know About Medicare And Cataract Surgery

Does Medicare Cover All the Costs of Cataract Surgery?

There are a few things beneficiaries should know about Medicares coverage of cataract surgery.

  • In order for Medicare to cover the cost of cataract surgery, a doctor must determine the procedure to be medically necessary.
  • The surgery must be performed at a Medicare-approved facility by a Medicare-participating doctor or a doctor who accepts Medicare assignment, and the supplier of your eyeglasses or contact lenses must also be enrolled in Medicare.
  • Medicare will only pay for a basic set of intraocular lenses and eyeglasses with basic frames. More advanced intraocular lenses or frames may require you to pay some or all of the cost.
  • After cataract surgery, you will usually be prescribed eye drops or an antibiotic, which may be covered by a Medicare Part D plan or Medicare Advantage plan that includes prescription drug coverage. These medications will not be covered by Original Medicare.
  • The cost of a cataract surgery performed with a laser is generally more expensive than when a laser is not used.

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When Does Humana Pay For Cataract Surgery

All Medicare Advantage plans are required by law to provide at least the same minimum coverage as Original Medicare, which is made up of Medicare Part A and Part B. And because Original Medicare covers cataract surgery, your Humana Medicare Advantage plan will too.

For cataract surgery, Original Medicare covers:

  • Removal of the cataract
  • A basic lens implant
  • One set of prescription eyeglasses or contact lenses following the surgery

Your costs with Original Medicare will include the annual Medicare Part B deductible along with a 20% coinsurance payment for the remaining balance of the Medicare-approved amount.

However, while Medicare Advantage plans must cover cataract surgery, they are allowed to implement their own deductible and cost-sharing requirements. Your exact costs will depend on the Humana Medicare Advantage plan in which you are enrolled.

You will also likely be required to have your cataract surgery performed at a health care facility that is part of your plans network, and you may also need to receive your post-operation eyewear from an eye doctor or other vision provider thats part of the Humana network.

If you are currently enrolled in a Humana Medicare Advantage plan, call the phone number on your plan ID card to ask about the details of your cataract surgery coverage or check your summary of benefits online in your MyHumana account.

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What Does Medicare Pay For Vision Care

Medicare generally doesnt pay for vision care or cover routine eye exams for eyeglasses or contact lenses, which means you are responsible for 100 percent of the cost. There is one exception though: Medicare Part A may cover vision care for patients admitted to the hospital when their vision is deemed a medical problem.

Medicare Part B covers cataract removal since its deemed medically necessary. This coverage also includes artificial lenses and products to correct vision, such as prescription glasses with frames. Individuals typically pay 20 percent of the Medicare-approved amount for vision care items such as glasses or contact lenses after their cataract surgery. Medicare Part B covers some vision care, but it doesnt cover vision exams or eye refractions.

Medicare Part B also covers a set of contact lenses and prescription eyeglasses needed after cataract surgery. Medicare covers intraocular lens implants for cataract surgery, but advanced implants are generally not covered. Medicare Part D, or prescription coverage, may cover certain vision-care products, such as prescription eye drops or other vision-related prescriptions.

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Dont Rush Through Abn Completion:

Prepare to set aside time to talk with the patient about this form and its contents. As a supplier, youre responsible for carefully reviewing what insurance wont pay with the patient ahead of time. You must also answer all of the patients questions, before the patient signs, says CMS in its ABN form instructions. Most practices place a high premium on efficiency, but when it comes to the ABN, this can have unintended consequences. Providers try to breeze through it as fast as possible, not taking enough time to answer patients questions, says Holt.

You must deliver the form far enough in advance so that the beneficiary has time to consider the options and make an informed choice, according to CMS. The advance preparation part of the ABN process is the key challenge for most practices, says Rhonda Buckholtz, CPC, CPCI, CPMA, CDEO, CRC, CHPSE, COPC, CENTC, CPEDC, CGSC, vice president of strategic development for Eye Care Leaders. The beneficiary needs to have adequate notice prior to performing the service and must know Medicare may not cover it. The beneficiary must also be informed the reason why and how much it will cost, she continues.

Resource: For more on ABNs and CMS-R-131 form, visit .

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Does Medicare Pay For Laser Cataract Surgery In 2020

Medicare Coverage – Medicare Vision Coverage: Does Medicare cover Cataract Surgery

Medicare coverage and payment for cataract surgery is the same irrespective of whether the surgery is performed using conventional surgical techniques or a bladeless, computer controlled laser. Under either method, Medicare will cover and pay for the cataract removal and insertion of a conventional intraocular lens.

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Does Medigap Cover Cataract Surgery

Medicare Supplement Insurance plans, more commonly known as Medigap, cover a variety of out-of-pocket costs under Original Medicare. One of these is your Medicare Part B coinsurance or copayment. Medigap Plan K pays 50 percent of your Part B coinsurance while Medigap Plan L pays 75 percent. All other Medicare Supplement plans cover 100 percent of your Part B coinsurance or copayment.

When Do Blue Cross Blue Shield Medicare Plans Pay For Cataract Surgery

While benefits may differ from one plan to another, Blue Cross Blue Shield Medicare Advantage plans will generally cover cataract surgery that implants a monofocal intraocular lens. If a more advanced lens is used for the implant, it may or may not be covered.

Its common for a patient to be prescribed a pair of eyeglasses following cataract surgery, or for a previous prescription to be modified after the procedure. A Blue Cross Blue Shield Medicare that includes BCBS Medicare vision coverage will typically help pay for some of the following:

  • Routine vision exams
  • Retinal imaging

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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.

Factors That Affect How Much You Pay

July 30, 2017

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.

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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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