Does Medicare Cover Cataract Surgery?

Cataract surgery is one of the most common surgical procedures performed on older adults in the United States.

According to the National Eye Institute, more than half of all Americans age 80 or older either have cataracts or have had surgery to get rid of them. Due to the increasing age of the population, the prevalence of cataracts is expected to rise, making it an important health concern.

Cataract surgery can help improve vision, reduce glare and enhance color perception but can be costly depending on your choice of provider and where you live. 

Thankfully, Medicare covers many aspects of cataract surgeries if they are medically necessary. 

So if you’re wondering “Does Medicare cover cataract surgery?” 

The answer is yes! 

In this blog post, we will discuss what types of procedures are covered by Medicare as well as other information to consider before you book a procedure with an eye specialist.

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How is cataract surgery covered by Medicare?

The short answer is yes, Medicare covers cataract surgery.

Part B covers cataract surgery and its associated costs, such as anesthesia, operating room facilities, and supplies. However, there are certain conditions that must be met for Medicare to cover cataract surgery.

Firstly, you must have a doctor’s referral that confirms you need cataract surgery to improve your vision. Medicare covers cataract surgery if the surgery is necessary to improve your vision to the level required for driving, reading, or other activities of daily living.

Secondly, you must ensure that your cataract surgeon accepts Medicare. Not all doctors accept Medicare, so it is essential to confirm this before undergoing the surgery. If your doctor accepts Medicare, they will file a claim on your behalf, and Medicare will pay for the covered expenses.

Thirdly, you must pay the Part B deductible. As of 2023, the Part B deductible is $226 per year. Once you have paid the deductible, Medicare will cover 80% of the Medicare-approved cost of the cataract surgery. You will be responsible for paying the remaining 20%.

Cataract Surgery is not part of Vision Insurance

Cataract surgery can sometimes be misconstrued as being covered under “vision” insurance, but it’s actually covered under Medicare Part B as an outpatient procedure.

While vision insurance may cover routine eye exams and corrective lenses, it typically does not cover surgeries such as cataract removal. Medicare Part B, on the other hand, covers medically necessary procedures, including cataract surgery.

However, even though cataract surgery is covered under Medicare Part B, there may still be out-of-pocket costs, such as deductibles and coinsurance. This is where Medicare Supplement Insurance plans can be helpful in covering those costs.

It’s important to understand the specifics of your insurance coverage and speak with your healthcare provider to ensure you have a clear understanding of the costs associated with cataract surgery.

How do Medicare Supplement Insurance Plans cover cataract surgery?

Medicare Supplement Insurance Plans, also known as Medigap, can help cover the costs associated with cataract surgery. Original Medicare (Part A and Part B) covers some aspects of cataract surgery, such as the surgical procedure itself and a portion of the associated costs.

However, there may be out-of-pocket expenses left over, such as deductibles, copays, and coinsurance. Medigap plans can help cover these costs, depending on the specific plan you have. Medigap plans typically supplement the ‘gaps’ that are not covered by Parts A and B.

It’s important to note that Medigap plans are sold by private insurance companies, so the specific coverage and costs may vary depending on the plan you choose.

How do Medicare Advantage Plans (Part C) cover cataract surgery?

If you have a Medicare Advantage plan, also known as Part C, you may have additional benefits and lower out-of-pocket costs for cataract surgery.

Medicare Advantage plans are offered by private insurance companies approved by Medicare and provide the same coverage as Parts A and B. Cataract surgery is generally covered under Outpatient Hospital services for Part C plans.

In summary, Medicare covers cataract surgery if it is medically necessary to improve your vision. To be eligible for coverage, you must have a doctor’s referral, ensure that your cataract surgeon accepts Medicare, ensure they are in network, and pay the Part B deductible. A beneficiary would also need to confirm that the surgeon is in the Medicare Advantage plan’s network. If you have a Medicare Advantage plan, you may have additional benefits and lower out-of-pocket costs.

It is essential to talk to your doctor and insurance provider to understand the costs and coverage details before undergoing cataract surgery.

What are cataracts?

Cataracts are the clouding of the lens in the eye, which results in a decrease in vision. They can occur in one or both eyes.

These can cause: 

• blurred vision
• sensitivity to light
• double vision
• or difficulty in seeing at night

Cataracts usually develop gradually over time and are more common in older adults. When left untreated, cataracts can lead to significant vision impairment.

Fortunately, cataract surgery is a safe and effective procedure that can help restore your vision. 

Read on to learn more about what cataract surgery is, who it’s for, and the potential risks associated with it. 

What Is Cataract Surgery? 

Cataract surgery involves removing the lens of the eye that has become cloudy due to age-related changes or other factors. Once this lens is removed, an artificial lens is inserted in its place so that light can pass through and focus properly on the retina. This new lens helps restore clarity and sharpness to your vision.

Who Is Cataract Surgery For? 

Cataract surgery is typically recommended for patients who have difficulty performing everyday tasks due to impaired vision caused by cataracts. 

If you experience blurry vision, increased sensitivity to light or glare, double vision, or any other visual disturbances due to cataracts, your doctor may recommend cataract surgery as a treatment option. 

What are the different parts of Medicare?

Medicare is a federal health insurance program that primarily covers people aged 65 and older. It also covers individuals with certain disabilities, those with End-Stage Renal Disease (ESRD), and those with Amyotrophic Lateral Sclerosis (ALS).

Medicare is divided into four parts – Part A, Part B, Part C, and Part D. Part A covers hospital care, while Part B covers medical services such as doctor visits, outpatient care, and preventive services.

With the rising cost of healthcare and the increasing need for medical services, understanding Medicare and its coverage is crucial for those eligible for the program.

Each part covers different types of healthcare services and has different costs associated with it.

Part A

Part A helps cover hospital care, skilled nursing facility care, hospice care, and some home health services. If you or your spouse has paid Medicare taxes for at least ten years, you are eligible for premium-free Part A coverage. If you do not meet the ten-year requirement, you can still enroll in Part A but may need to pay a premium.

Part B

Part B helps cover medical services such as doctor visits, outpatient care, and preventive services. Some of the services covered under Part B include lab tests, medical equipment, ambulance services, and mental health services. Part B also covers some vaccines and screenings. There is a monthly premium for Part B, and the amount varies depending on income.

Part C

Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B) offered by private insurance companies approved by Medicare. Medicare Advantage plans must cover all the services that Original Medicare covers, but they may have different costs, coverage, and rules. Some Medicare Advantage plans may also offer additional benefits such as dental, vision, or hearing coverage.

Part D

Part D covers prescription drug coverage. It is offered by private insurance companies approved by Medicare, and the plans vary in terms of costs and the specific drugs they cover. Medicare beneficiaries can choose a Part D plan that best fits their needs.

In summary, Medicare is a federal health insurance program that provides coverage to eligible individuals for hospital and medical services, prescription drugs, and other health-related needs.

Understanding the different parts of Medicare and their coverage can help individuals make informed decisions about their healthcare needs and choose the coverage that is best for them. It is important to note that while Medicare covers many healthcare services, there are still some out-of-pocket costs associated with the program, so it is essential to plan for these expenses.

What to Consider When Getting Cataract Surgery

While cataract surgery is generally considered safe and effective, there are several factors to consider before undergoing the procedure. 

In this section, we will discuss what to consider when getting cataract surgery.

Finding a Doctor Who Accepts Medicare

If you are covered under Medicare, it is important to find a doctor who accepts Medicare. Not all doctors and healthcare providers accept Medicare, so it is important to verify that your doctor is in-network to avoid paying higher out-of-pocket costs.

Medicare Advantage Plans

If you are enrolled in a Medicare Advantage plan, you may have different coverage options for cataract surgery. Some Medicare Advantage plans may cover additional benefits such as vision or hearing coverage that can be beneficial for cataract surgery. However, it is important to review your plan’s coverage and network to determine what out-of-pocket costs you may be responsible for.

Out-of-Pocket Costs

While Medicare covers many of the costs associated with cataract surgery, there may still be out-of-pocket costs, such as co-pays, deductibles, and additional fees. It is important to review your Medicare plan and any other insurance coverage you may have to understand what your out-of-pocket costs may be.

Preparing for the Procedure

Before undergoing cataract surgery, it is important to prepare for the procedure. This may include undergoing preoperative testing, such as an eye exam and blood work, and discussing any medications or supplements you are currently taking with your doctor.

Recovery and Follow-Up Care

After cataract surgery, you will need to follow specific instructions from your doctor to ensure proper healing and recovery. This may include taking prescription eye drops, avoiding certain activities, and attending follow-up appointments with your doctor.

In conclusion, cataract surgery is a common procedure for treating cataracts, but there are several factors to consider before undergoing the procedure. These include finding a doctor who accepts Medicare, understanding your Medicare coverage and out-of-pocket costs, preparing for the procedure, and following proper recovery and follow-up care. By considering these factors, you can make informed decisions about your healthcare needs and ensure a successful cataract surgery outcome.

How much does cataract surgery cost?

In this section, we’ll discuss the various factors that go into determining the cost of cataract surgery. 

Factors That Affect Surgery Costs

The exact cost of cataract surgery will vary depending on a few different factors. This includes the type of lens implant you choose (if any), your insurance coverage, the location of your procedure, and more.

The following is a breakdown of some of the most important considerations when it comes to understanding cataract surgery costs. 

Insurance Coverage 

The vast majority of insurance providers cover some or all of the cost associated with cataract surgery. However, they may have limits on which lenses they cover or what types of procedures they will pay for.

It’s important to check with your specific provider before assuming that all costs will be covered. 

Type Of Lens Implant

If you opt for a lens implant as part of your procedure, there are a few different options available. Intraocular lenses (IOLs) come in monofocal and multifocal varieties and each one has its own associated cost range. Monofocal lenses typically cost $1,000-$2,000 per eye while multifocal lenses can be up to $3,000 per eye or more depending on the brand and type you choose. 

Location Of Procedure

Another factor that can affect the price is where you choose to have your procedure performed. A typical outpatient facility may charge anywhere from $3,000-$5,000 per eye while an ambulatory surgical center could charge up to $4,000-$6,000 per eye depending on their location and services offered. 

Additionally, if you live in an area where there are multiple surgeons offering cataract surgery services at competitive prices then you may be able to negotiate a lower rate than what is listed above. 

It’s essential for Medicare beneficiaries to understand their coverage options and to work closely with their healthcare providers to ensure that they receive the care they need without incurring unnecessary expenses. By taking advantage of the coverage offered by Medicare, individuals can address their cataracts and enjoy improved vision and quality of life.

If you have questions about your plan or coverage on cataract surgery, please reach out to a licensed sales agent at Apollo. We would be happy to help!

Source: 2023 National Eye Institute

Source: 2023 Medicare and You Handbook

Source: 2023 College of Medicine at University of Central Florida