Thursday, June 20, 2024

What Will Medicare Pay For Cataract Surgery

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Paying For Cataract Surgery

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

Ultimately, insurance coverage greatly offsets the overall cost of cataract surgery, but even with coverage, patients still incur some out-of-pocket costs. Many insurance plans offer at least partial coverage for cataract surgery, but it may not be enough to cover everything.

For individuals in need of financial assistance for vision care, many organizations across the country offer help. Depending on the organization, help can come in the form of financial support, free services, reimbursement and insurance assistance, and more.

Visit Prevent Blindness to see if you qualify for any additional financial assistance for vision 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.

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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If You Have A Medicare Advantage Plan

Medicare Advantage plans, insurance plans offered by private insurance companies, combine Part A and Part B benefits. Medicare Advantage plans often cover services that Original Medicare doesnt, including vision care. Depending on your health-care needs, these plans may be the best Medicare option for you.

Cataract surgery is typically covered by Medicare Advantage plans, but how much you have to pay out of pocket is based on your premium, deductible, and coinsurance or copayment amount.

When Does Medicare Pay For Cataract Surgery

Does Medicare Cover Cataract Surgery?

Medicare Part B and all Medicare Advantage plans cover preoperative and postoperative eye exams, the removal of the cataract, the insertion of basic lens implants and one set of prescription eyeglasses or one set of contact lenses following the procedure.

Hospitalization is typically not needed for cataract surgery. But should hospitalization occur as a result of any complications, your hospital stay will be covered by Medicare Part A and all Medicare Advantage plans.

There are two main types of cataract surgery, phacoemulsification and extracapsular. Medicare provides coverage for both.

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Does Private Insurance Cover Cataract Surgery

Most health insurance providers consider cataract surgery to be medically necessary. Therefore they will cover at least a portion of the costs associated.

Cigna, Aetna, United Healthcare, and other smaller insurance providers will all cover a significant part of your cataract surgery.

Speak directly with your healthcare provider to find out what is covered by your plan.

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. 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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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.

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What’s The Best Medicare Supplement Plan For Cataract Surgery

The 2020 CMS payment reduction for cataract surgery. The systemic problem and proposed solutions.

Signing up for a Medicare Supplement plan will give you better coverage for cataract surgery than if you only had Medicare Part B. Those who sign up for a Medigap plan will also need a separate plan for prescription drug coverage.

Medigap plans have standardized coverage by plan letter. For example, if you have Plan G, you’ll have the same surgery costs no matter what company you choose.

Medigap plans:

  • We recommend: Plan G for best overall coverage across all medical needs.
  • Also good: Plan A, B, D, G, M and N pay 100% of Part B coinsurance, which is your portion of cataract procedure costs.
  • Best plans if you’re eligible: Plan C and Plan F pay 100% of the Medicare Part B coinsurance and the Part B deductible. However, to be eligible for these plans, you need to have qualified for Medicare before 2020.

Medigap providers we recommend

Cheap rates, helpful member resources and Medigap plans have wide availability.

Select a Medicare Supplement company that:

  • Has the best monthly costs for the plan letter you choose
  • Includes discounted vision care or offers add-on vision insurance
  • Has good customer experience with few complaints

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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

When Medicare Pays For Eye Exams And Glasses

Medicare only covers medical eye exams and relatedtreatments, with a few exceptions. Since Part A is your hospital coverage, coverage would only kick in if you suffer a traumatic eye injury or emergency that requires you to be admitted to the hospital. Most of your eye care will be covered by Part B.

Eye exams Medicare Part B covers

If you need a medical eye exam , your exam and care are covered by Part B.

Medicare Part B also covers cataract surgery, including the specific exams leading up to it. Heres when one of those previously mentioned exceptions appears: After cataract surgery, Medicare will cover one pair of conventional eyeglasses or conventional contact lenses after each surgery. This is the only time Medicare will pay for eyeglasses.

Medicare Part B also covers the following eye care services:

  • An annual glaucoma screening for high-risk patients. You are usually considered high risk if you have a family history of glaucoma, are an African American over age 50, are a Hispanic American over age 65, or if you have diabetes.
  • An eye prosthetic and certain maintenance of the prosthetic if you lose your eye due to trauma or surgical removal.
  • Certain screenings, diagnostic tests, and treatmentsfor age-related macular generation.
  • Contact lenses used to treat a medical condition.

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Read Also: How To Qualify For Medicare And Medicaid

Potential Medicaid Vision Benefits

Medicaid is designed to provide comprehensive health coverage to ensure the health of all Americans covered by Medicaid. For many people, comprehensive coverage includes vision care.

Vision benefits often covered by Medicaid include:

  • Vision screenings, testing, and treatment for children under the age of 21.
  • Annual eye exams for adults.
  • Contact or eyeglass coverage.
  • Medical and surgical procedures, such as cataract surgery.
  • Surgical treatment and emergency care.
  • Specialist consultations.

The above benefits are covered by various state Medicaid plans but not all. You must consult with your state-specific Medicaid agency to confirm which vision services are covered for you and your beneficiaries.

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Will Medicare Help Pay For Cataract Surgery?

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How Much Does Cataract Surgery Cost Without Insurance

Without insurance, cataract surgery can be very expensive. According to All About Vision, your cost is dependent on your location and the type of cataract surgery you get. If you dont have Medicare or private insurance, cataract surgery can cost between $3,783 to $6,898 per eye as of 2019. Complicated cases such as intraocular lenses for astigmatism or opting for laser cataract surgery can increase your cost.

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 To Keep Your Additional Vision Care Affordable

Now that you know your cataract surgery may be covered, its a good time to consider your comprehensive vision care. Many Medicare Advantage plans include vision coverage as part of the plans benefits. Additionally, senior vision insurance coverage is also available for those without Medicare Advantage plans. For even more convenience, there are also plans that combine vision, dental, and hearing coverage into a single policy.

Explore your options, compare coverage, and find a plan that suits your vision needs today with HealthMarkets.


Medicare Coverage For Cataract Surgery

Does Medicare Cover Cataract Surgery?

Medicare Part A covers hospital and inpatient costs. Its rare for a hospital stay to be required after cataract surgery, but in the small chance that you need to be admitted, Medicare Part A would cover this expense.

Medicare Part B takes care of other medical costs, including outpatient procedures. If your cataract surgery is approved for coverage by Medicare Part B, your pre-surgery exam and any post-surgery care will be covered. Ophthalmologist and facility fees are also covered by Medicare Part B.

Medicare Part C, also called Medicare Advantage plans, are purchased through private insurance retailers and offer different levels of coverage, combined with the coverage of Original Medicare . Depending on which plan you have, a majority of your cataract surgery cost could be covered.

Medicare Part D provides prescription drug coverage. Individuals who require prescription medication before or after cataract surgery can have the cost covered, as long as the prescription falls under Medicares list of approved medications.

Medigap is a Medicare supplemental plan that works to cover certain approved costs that Original Medicare does not. In some instances, this can include deductibles and copays however, its best to verify what these approved costs are with your healthcare provider.

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Cost Of Cataract Surgery Without Insurance

The average cost of cataract surgery in the United States is between $3,500 and $7,000 per eye.

Price variations may be due to various factors, such as these:

  • Regional variations
  • The type of lens implanted during the procedure
  • Surgeon expertise
  • The severity of your cataract
  • Whether its an outpatient or hospital procedure
  • Testing, exams, and medications
  • Extent of aftercare

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.

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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.

Why Should You Consider Lasik

Medicare Proposes Another Cut In Cataract Reimbursement

Itâs clear that scheduling surgery means paying at least some of the costs out of pocket. If your budget is tight and money is a concern, you may wonder why you should pay for a surgery like this. Wouldnât your money be better spent elsewhere?

The fact remains that LASIK is an exceptional solution for astigmatism, and surgery offers you a solid chance of seeing clearly without constant use of glasses or contact lenses.

For example, in a study published in The Open Ophthalmology Journal, researchers found that 90 percent of people who had LASIK due to myopia and myopia with astigmatism had uncorrected vision that was equal to or greater than 20/20. Studies like this demonstrate just how effective this surgery can be in helping people to avoid constant use of contacts or glasses. If that is your goal, this surgery could be the solution for you.

Only you know how much the ability to leave glasses behind is worth to you. Given results like this, you might be willing to move forward with surgery even if your insurance company decides not to pay for that care.

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Eyeglasses And Contacts After Cataract Surgery

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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