Is Cataracts Surgery Covered By Medicare?

It’s never too early to start planning for your future. To explain, if you are a person with cataracts, Medicare will cover the costs of a procedure, but it is important that you know what your coverage will be before making any decisions about treatment.

While Medicare does not pay for regular vision care such as eye checks, glasses or contact lenses, it does cover cataract surgery. Medicare coverage for cataract surgery is dependent on whether the operation is necessary and if the doctor who performs it accepts Medicare as payment.

Cataract surgery is a common procedure that is often covered by Medicare. However, there may be some out-of-pocket costs associated with the surgery, so it’s important to understand what your coverage entails. This post will provide an overview of cataract surgery and Medicare coverage. Stay tuned for more information on the costs of this procedure!

What are Cataracts?

A cataract clouds the eye’s lens and it happens to affect vision. Usually, they form slowly. Hence, when cataracts start blocking light is when many people notice they are forming. After a long time, things look blurry, hazy, or less colorful. Problems usually start with reading and other everyday activities when cataracts start to form. Doing simple things like reading may be hard for you. Furthermore, vision problems due to cataracts affect half of the people between 65 and 74.

Exposure to sunlight may increase the risk of having cataracts in the long term. Also, if you smoke, or have diabetes. In accordance to National Eye Institute, almost half of all Americans will either have it or have had cataract surgery by the age of 70. If you get cataracts, you shouldn’t worry there’s hope! The great news is getting rid of cataracts is easy. How? Through Cataract Surgery. I know you have questions in mind. Is it safe? How much does it cost? Does Medicare cover it? 

Can Cataract Surgery Improve Your Vision?

First of all, it’s proven to correct vision problems and it’s not harmful. And yes, cataract surgery is considered Medicare Part B service. Medicare will pay 80% of your cataracts surgery after you fulfill the very small Medicare Part B annual deductible. This is great but you will be responsible to pay the other 20% that Medicare doesn’t pay. However, this is where I come in as an independent agent. I help people just like you every day find the exact right Medicare Supplement plan that will pay the other 20% Medicare doesn’t pay for.

Also, Medicare dictates that every company must have the exact same benefits for the letter plan you are looking at. It states on page 9 of The Guide to Buying a Medigap policy, “cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies”. What this means is if you buy a Plan G with one company you know the benefits, doctors, etc will be the exact same and price will be the only difference. I help those new to Medicare find the best Medicare Supplement plan for their needs, with the best company and at a competitive price.

Medicare Coverage for Cataract Surgery
Medicare Coverage for Cataract Surgery

Does Medicare Cover Intraocular Lenses?

If you have cataract surgery to insert an intraocular lens, corrective lenses will be paid by Medicare Part B (Medical Insurance). However, Medicare doesn’t generally cover eyeglasses or contacts. Original Medicare does cover cataracts surgery, in general. The Medicare beneficiary will be responsible to pay 20% and the other 80 percent is covered by Original Medicare. In addition, Medicare Part B also includes the following:

  • Rubbing out of cataract
  • Primary lens impact
  • One kit of medication eyeglasses or one kit of contact lenses after the surgery

But, does Medicare cover laser cataract surgery? Thankfully, It’s a yes. Medicare covers the use of laser in surgery.

What You Need to Know:

  • In the absence of insurance, cataract surgery generally costs between $3,893 and $6,998
  • However, Original Medicare doesn’t normally contain vision coverage but covers cataract surgery
  • For you to be eligible, cataract surgery must be performed with traditional surgical procedures and lasers.
  • On the other hand, Medicare Advantage plans does cover cataract surgery

What Cataract Surgery Does Medicare Cover?

The most common cataract surgery procedures use computer-controlled lasers and conventional techniques and Medicare covers that. 

  • Phacoemulsification it’s a method used to break up and then eliminate a cloudy lens, or cataract, from the eye to improve vision using an electronic device
  • Secondly, LASIK surgery has a similar extensive prescription as laser-assisted surgery during this method, your doctor uses the laser to make all incisions to soften the cataract removal by ultrasound 

Medicare only covers the costs corresponding to cataracts.

Is Cataract Surgery Performed in Office?

Outpatient operation is where cataract surgery is normally performed in a doctor’s office or in a hospital. It means you can go home after undergoing surgery. Private insurance companies provide Medicare Advantage Plans, it’s an association of Medicare Part A and Medicare Part B benefits. Depending on your healthcare requirement, you are still responsible to pay a portion of your cataract surgery with Original Medicare. Cataract surgery falls under Part B (cataract surgery is covered under Medicare Part B, this covers outpatient and doctor’s services).

To learn more about Medicare Part B, kindly visit this link: https://trustedbenefitsdirect.com/medicare-part-b-surprisingly-allows-no-out-of-pocket-maximums/. Depending on the Medicare Advantage plan you have you’ll be responsible maybe for a deductible and a copay. Most of the Medicare Advantage Plans I provide have a $0 health deductible and also a copay for cataract surgery. Usually, it’s around $100 or $200 but some of the plans I represent have a $0 copay for the surgery. It just depends on what area of the county you live in and the plans available. 

Does Medicare Cover Mono-focal Lenses for Cataract Surgery?

Medicare and private insurance normally cover standard cataract surgery, this includes monofocal implants. However, they don’t cover the extra cost for a refractive cataract surgery that contains premium IOL (intraocular lens) and/or a laser. Medicare covers typical cataract surgery corresponding with just about 80% of the cost. Eventually, the program that leaves the patient responsible for 20% of their bills after they meet a deductible is proving to be so successful, it’s gaining national recognition. (the Medicare Part B deducible is $203 for 2021)

How Much Does Cataract Surgery Cost Without Insurance?

As of 2021, cataract surgery can cost between $3,943 to $7,046 per eye if you don’t have Medicare or private insurance. As a matter of fact, prices may increase for complex cases of astigmatism or selecting laser surgery, especially (IOLs). Media, H. (2020, December 22). Does Medicare cover cataract surgery? Retrieved from https://www.marketwatch.com/story/does-medicare-cover-cataract-surgery-01608297518

Standard Cataract SurgeryMedicare CoverageOut-of-PocketDeductibleTotal Cost to Patient

Let’s have some examples: 

  • Firstly, If the patient cited above picked out a presbyopia-correcting premium IOL, that would charge him/her $883 + $2,500 ($3,383)
  • For example, if the patient cited in the table cost expense and wants to have surgery with a premium toric IOL to repair astigmatism, he/she may be in charge for the $883 + $1,500 ($2,383), toric IOL’s average cost
  • If you undergo sensor cataract surgery, an extra $1,500 will be added.

Pursuing LASIK or other surgical treatments for eye correction is a good option if the patient wants to ditch their glasses and contacts. Mainly, the potential out-of-pocket costs can practically double or triple by exclusive cataract surgery.

Original Medicare Coverage

Original Medicare covers Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Subject to Original Medicare, you’re in charge of the remaining 20% of expenses, including:

  • Deductibles
  • Coinsurance involving cataract surgery and exams
  • Copayments 

The eyeglasses or contacts advised after surgery falls under Medicare Part B coverage. Even though Medicare Part A covers hospital expenses, you likely won’t need hospital admission for cataract surgery. You may enroll in a Medicare Supplement if you don’t like to be responsible for out-of-pocket that runs additional costs which are not covered by Original Medicare. Having a Medicare Advantage Plan means the corrective glasses or the cataract surgery or contact lenses will be paid for by your Medicare Advantage provider. Medicare Advantage plans need to provide the base level of benefits recommended through Original Medicare coverage. Medications advised to your post-surgery as well as eye drops may be covered by Medicare Part D prescription plan.

Does Medicare Cover Lenses?

Medicare pays only for lenses and glasses provided by Medicare-enrolled suppliers, make sure to discuss it with your trusted ophthalmologist. Must be remembered, it is my business to help you find the plan that is best for you. One of the major disadvantages of Medicare Advantage in my opinion is the potential of restrictive HMO doctor networks, you must use to have coverage. 

With an HMO and most of my clients that get a Medicare Advantage choose to get an HMO because in general, they have the lowest costs. You need to use the referral system. You must see your primary care doctor and they will refer you to a specialist. Moreover, there are also PPO plans which allow you a wider network of doctors and specialists to use, and also the PPO plans have out-of-network coverage as well. But in general, the PPO plans have higher premiums, deductibles, copays, and out-of-pocket maximums

Key Takeaways

  • Firstly, you must pay 100% for excluded services that includes contact lenses or eyeglasses
  • Secondly, for corrective lenses after each cataract surgery with an intraocular lens, you pay 20% of the Medicare-approved amount, and also the Part B deductible is implemented
  • Thirdly, for enhanced frames, you pay any added costs
  • Lastly, Medicare will pay for contact lenses or eyeglasses from a provider that is registered in Medicare, no matter if you or your provider submits the claim

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