We rely on our sight for so many things. From looking through photographs to enjoying the beautiful scenery, our ability to see connects us with the rest of the world.
Our bodies undergo various changes as we age, and our eyesight is no exception. Cataracts can grow over time, causing the lenses in our eyes to become cloudy and making our vision blurry. They are a common age-related vision problem that can significantly impact our daily lives. In fact, approximately 20% of people over 65 and 50% of those over 75 develop cataracts.
Cataract surgery is a proven solution to restore clear vision. However, the surgery’s cost can raise concerns, especially if you rely on Medicare for your healthcare coverage. In this guide, we will discuss your Medicare coverage for cataract surgery.
Does Medicare cover cataract surgery?
The short answer is yes. Medicare will cover cataract surgery under Part B (outpatient services) or your Medicare Advantage plan. This may surprise you, as Original Medicare does not cover routine vision care.
Does Medicare cover all types of cataract surgery?
However, Medicare does not cover all cataract surgery.
First, Medicare will cover cataract surgery that is “medically necessary.” Your doctor will need to provide documentation that you need this procedure done.
Cataract surgery can be performed using different techniques, and the type of intraocular lens (IOL) used can also vary. Medicare generally covers traditional cataract surgeries, which involve the insertion of a small, clear, conventional, or monofocal intraocular lens (IOL) with the help of lasers or other equipment.
Medicare might not fully cover the cost if you opt for advanced lens options, such as certain types of posterior chamber intraocular lenses (PC-IOLs) or anterior chamber intraocular lenses (AC-IOLs).
In these cases, while Medicare will typically cover the amount equivalent to what it costs for a standard lens, you may be responsible for any difference in cost between the standard lens and the more advanced lens. As always, the specifics can vary, so it’s important to discuss the details with your doctor and Medicare provider.
How much does cataract surgery cost?
The cost of cataract surgery can vary. The price will depend on where you live, the surgeon’s experience, and the type of surgery. Generally, cataract surgery costs include pre-operative consultations, the procedure, and post-operative care.
Cataract Surgery: Inpatient vs. Outpatient
The setting where your cataract surgery is performed can affect the cost and how Medicare covers it. Most cataract surgeries are performed as outpatient procedures, meaning you go home the same day. However, in some cases, an overnight hospital stay may be required.
When cataract surgery is performed in an outpatient setting, it’s covered under Medicare Part B. If the surgery requires an overnight stay in a hospital, it’s covered under Medicare Part A. In both cases, you will typically be responsible for a portion of the cost, but the amounts can vary. Be sure to discuss this with your healthcare provider and Medicare plan administrator to understand any potential cost differences.
Costs without insurance
If you do not have coverage, cataract surgery will put a significant dent in your savings. On average, the costs for the surgery alone are between $3,000 to $5,000 per eye.
Costs under Medicare
Medicare significantly reduces your out-of-pocket costs for cataract surgery. Medicare Part B covers 80% of the Medicare-approved amount for cataract surgery. These costs include the surgeon’s fees, the intraocular lens (IOL) implant, and necessary follow-up visits.
However, you are still responsible for the Medicare Part B deductible ($226 in 2023) and must pay the 20% coinsurance.
If you have a Medigap policy, also known as Medicare Supplement Insurance, it can help cover some of these out-of-pocket costs not covered by Original Medicare. This may include the Part B deductible and the 20% coinsurance, depending on the specific Medigap policy you have.
Medicare Advantage Plans
If you have a Medicare Advantage plan, you might have access to even more comprehensive coverage for cataract surgery. Some plans offer reduced or even zero coinsurance for cataract surgery. However, you must ensure your surgeon is within your plan’s network. Remember, coverage and costs can vary greatly among Medicare Advantage plans, so it’s essential to find a plan that meets your needs best.
Does Medicare cover eyeglasses after cataract surgery?
While Original Medicare typically doesn’t provide coverage for eyeglasses or contact lenses, there is an exception for those who’ve undergone cataract surgery. After cataract surgery that involves an intraocular lens implant, Medicare Part B will help cover the cost of one pair of corrective eyeglasses or one set of contact lenses. It’s important to note, however, that coverage only applies if these corrective lenses are prescribed by a doctor who accepts an assignment from Medicare.
Eye drops and ointments after cataract surgery
Depending on your recovery, you might require eye drops, antibiotics, or other medication daily for several weeks after your surgery. Medicare Part D under Original Medicare or your Medicare Advantage plan will cover your post-surgery prescriptions.
Understanding Your Medicare Coverage with The Medicare Family
Navigating the intricacies of Medicare coverage can be overwhelming, especially when it comes to specialized procedures like cataract surgery. That’s where The Medicare Family comes in. We specialize in helping individuals understand their Medicare options, coverage details, and potential costs.
For over 40 years, our dedicated team of experts has been guiding seniors through the process, ensuring that you make informed decisions about your healthcare coverage. Schedule your complimentary call today with our team of experts to learn more!