Thursday, February 22, 2024

When Does Medicare Pay For Cataract Surgery

Don't Miss

Medicare Coverage For Cataract Surgery

Medicare – Will it Pay For 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.

  • Extent of aftercare

Eyeglasses & Contact Lenses

Medicare doesnt usually cover eyeglasses or contact lenses. However, Medicare Part B helps pay for corrective lenses if you have cataract surgery that implants an intraocular lens. Corrective lenses include one pair of eyeglasses with standard frames or one set of contact lenses.

You pay 100% for non-covered services, including most eyeglasses or contact lenses. After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount for corrective lenses after each cataract surgery with an intraocular lens. You pay any additional costs for upgraded frames. Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter if you or your supplier submits the claim.

Which Parts Of Medicare Do You Need For Cataract Surgery

Cataract surgery is covered by Medicare Part B, which covers outpatient services. Most Medicare Advantage plans also cover cataract surgery coveragethough youll need to select a provider and facility that are in-network with your specific plan.

Original Medicare covers 80% of the cost of cataract surgery, and patients are responsible for paying the remaining 20% after meeting their yearly Part B deductible.

Medicare Advantage plans, however, may require a copay. Regardless, be sure to get a full rundown on your policy before booking any appointments. You can also use Medicares procedure price lookup tool to get an idea of potential costs.

Don’t Miss: Can Doctors Charge More Than Medicare Allows

Medicare And Cataracts: Taking The Fear Out Of Removing Cataracts

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.

How Much Does Medicare Pay For Cataract Surgery In 2022

Does Medicare Cover Cataract Surgery

Asked by: Prof. Reginald Daugherty DVM

Under Medicare’s 2022 payment structure, the national average for allowed charges for cataract surgery in outpatient hospital units is $2,079 for the facility fee and $548 for the doctor fee for surgery on one eye. Of the $2,627 total, Medicare pays $2,101 and the patient coinsurance is $524.

Don’t Miss: What Will Medicare Pay For Cataract Surgery

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.

Designing Your Eyecare Treatment Plan

At Poudre Valley Eyecare, our optometrists can help you take control of your eye health by performing a comprehensive eye exam and designing a treatment plan that meets your needs. Our family-run practice offers premier eye care to the Front Range of Colorado, including Fort Collins, Loveland, Wellington, Timnath and Greeley.

For more information and guidance around your vision and eyecare treatment plan, contact our team today. Find detailed information about your Medicare coverage at

Recommended Reading: What Month Does Medicare Coverage Begin

Also Check: Does Medicare Pay For Maintenance Chiropractic Care

What Aspects Of Cataract Surgery Does Medicare Not Cover

Medicare will pay costs associated with the placement and maintenance of a standard lens. But there are lenses that correct your vision for astigmatism or age-related presbyopia, and you may want one of those instead.

If you get a specialty lens, you may need additional treatments, services, or supplies for placing, adjusting, or monitoring it. But any cost that exceeds Medicares approved amount for standard cataract surgery and care wont be covered. Instead, those extra costs will be billed to you.

Also, if you get a specialty IOL, Medicare will not pay for eyeglasses or contact lenses. Its reasoning is that a vision-correcting IOL does the jobs of both a standard IOL and a pair of prescription eyeglasses.

Paying For Cataract Surgery

Does Medicare Cover Cataract Surgery?

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.

Also Check: Do You Have To Apply For Medicare At 65

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.

When Does Medicare Cover Cataract Surgery

Since cataract surgery can cost over $13,500 if you need surgery on both eyes, youre likely wondering if Medicare will cover cataract surgery.

Medicare covers standard cataract surgery for people who are 65 or older. Original Medicare will even pay for corrective lenses if you have surgery to implant an IOL. Under your Medicare Part B benefits, Medicare will pay for one pair of prescription eyeglasses with standard frames or a set of contact lenses.

But does Medicare cover laser cataract surgery? Luckily, the answer is yes. Medicare coverage includes surgery done using lasers.

Medicare Part B benefits only cover the Medicare-approved amount for cataract surgery. Youll also have to pay your deductible, plus a 20% Medicare Part B copay.

Also Check: What Weight Loss Programs Are Covered By Medicare

Recommended Reading: How Much Does Medicare Cost A Person

Where Can I Ask Questions About Cataract Surgery And Medicare

If youre enrolled in Original Medicare, you may call Medicare at 1-800-MEDICARE for questions about coverage of cataract surgery.

You can also compare Medicare Supplement plans online to find out if a plan is available near you that can help cover the out-of-pocket Medicare costs of cataract surgery.

Nonsurgical Cataract Treatment And Medicare

Does Medicare Pay for Cataract Surgery?

There are several nonsurgical cataract treatment options to consider. Some people may delay cataract surgery since cataracts often worsen slowly. Nonsurgical options include wearing sunglasses that block harmful UV rays, investing in new prescription glasses or contacts, making lifestyle changes, and seeking vision correction from an ophthalmologist. All these options are based on your unique situation, so its best to consult a doctor to see whether they advise nonsurgical cataract surgery.

Medicare generally doesnt cover nonsurgical cataract treatments. There is an exception, however, for patients who have undergone cataract surgery and then require nonsurgical cataract treatments. Medicare Part B, for instance, helps pay for corrective lenses on the condition that you are undergoing cataract surgery to implant an intraocular lens. You would receive one pair of eyeglasses with standard frames or a pair of contact lenses. If you have a Medicare Advantage plan, then check whether your plan offers additional benefits for vision.

If you find that nonsurgical cataract treatment does not help your vision, it may be time to consult a doctor about surgical cataract treatment.

Pro Tip: Hospice involves both attentive medical care and palliative care assistance to terminally ill patients. Read my article Does Medicare Cover Hospice?

Don’t Miss: Can I Have Humana And Medicare

What Are The Roles Of A Medicare Supplemental Plan

Along with Original Medicare, Medigap or Medicare Advantage, which are plans from private insurers that anyone 65-or-older with Medicare parts A & B may apply for, may be used to extend your coverage.

For instance, premium cataract surgery such as to repair an astigmatism or presbyopia may not be fully covered by Medicare. However, Medigap may be able to help cover the cost, which can be as much as 3-times that of standard cataract surgery.

Theres also Medicare Advantage, which is a plan that replaces Medicare Parts A & Part B, and may cover standard vision care , as well as other expenses not covered under Medicare Parts A & B.

The cost of these plans may vary, and while they typically offer lower out-of-pocket expense, your choice of physicians under them may be limited.

Does Medicare Pay For Laser Cataract Surgery In 2022

If you require cataract surgery, Medicare will cover the procedure. In 2022, Medicare will pay the same amount for the surgery whether your Medicare-approved doctor uses a laser or not. If there is a cost difference between the two procedures, you will be responsible for additional costs because Medicare wont pay more for a more expensive procedure.

Are you eligible for cost-saving Medicare subsidies?

Read Also: How To Make Medicare My Primary Insurance

Why Should You Consider Lasik

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.

Eyeglasses And Contacts After Cataract Surgery

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

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.

You May Like: How To Report Suspected Medicare Fraud

Does Medicare Advantage Cover Cataract Surgery

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.

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.

Recommended Reading: Can I Buy Private Health Insurance Instead Of Medicare

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%.

When Does Medicare Pay For Cataract Surgery

Cataract Surgery: Do You Need Vision Coverage?

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.

Read Also: Are Pre Existing Conditions Covered Under Medicare

You May Like: Is Ibrance Covered By Medicare

What Is The Vivity Lens And What Are The Potential Benefits Of This Lens

The Vivity lens is a new artificial lens available for patients having cataract surgery. Just like there are different models and manufacturers of cars and refrigerators, there are different models and manufacturers of Intraocular lenses. The Vivity IOL is designed to give your eye a better range of focus compared to a standard monofocal IOL that is only focused at a single distance. The Vivity lens is considered an Extended Depth of Focus lens. The benefit of an EDOF lens is a better range of focus which will help you to see more things without glasses. As compared with a multifocal IOL the Vivity lens will have less negative side effects such as glare and halos around lights at night. The Vivity lens may not focus as close as the Panoptix lens so you may still need glasses for some near tasks such as reading small print. The Vivity lens is considered a high technology IOL so there is an extra cost for this lens that your medical insurance will not cover.


You May Like: Is Medicare Plan B Mandatory

More articles

Popular Articles