Friday, April 19, 2024

Does Medicare Cover Glasses After Cataract Surgery

Dont Rush Through Abn Completion:

Medicare Explained: Does Medicare Cover Cataract Surgery and Glasses?

Prepare to set aside time to talk with the patient about this form and its contents. As a supplier, youre responsible for carefully reviewing what insurance wont pay with the patient ahead of time. You must also answer all of the patients questions, before the patient signs, says CMS in its ABN form instructions. Most practices place a high premium on efficiency, but when it comes to the ABN, this can have unintended consequences. Providers try to breeze through it as fast as possible, not taking enough time to answer patients questions, says Holt.

You must deliver the form far enough in advance so that the beneficiary has time to consider the options and make an informed choice, according to CMS. The advance preparation part of the ABN process is the key challenge for most practices, says Rhonda Buckholtz, CPC, CPCI, CPMA, CDEO, CRC, CHPSE, COPC, CENTC, CPEDC, CGSC, vice president of strategic development for Eye Care Leaders. The beneficiary needs to have adequate notice prior to performing the service and must know Medicare may not cover it. The beneficiary must also be informed the reason why and how much it will cost, she continues.

Resource: For more on ABNs and CMS-R-131 form, visit .

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Medicaid & Cataract Surgery

More than 50 percent of Americans over the age of 80 have cataracts or have had cataract surgery. This very common procedure is used to restore vision that has been impacted by cloudy lenses. It is a safe and highly effective surgery to correct vision problems due to cataracts.

Medicaid is an insurance program that is available to qualifying low-income individuals, elderly adults, children, pregnant women, and people with disabilities. It is a federal program that is administered by each state. It is funded jointly by state governments and the federal government.

Each state Medicaid program must meet certain federal requirements, but there is also room for states to choose optional services to cover. Optometry services, including eyeglasses, are an optional service.

Children covered by Medicaid are covered for a vision screening at each well-child checkup. If any conditions that warrant further testing or treatment are discovered, the costs of those additional procedures are also covered.

For adults to receive coverage for vision services, the services must be deemed medically necessary. Medical necessity is determined by state.

When Does Aetna Medicare Pay For Cataract Surgery

Cataract surgery is often considered a medically necessary procedure, and your doctor will refer you for surgery upon a diagnosis of cataracts and vision impairment.

Some Aetna Medicare Advantage plans may require prior authorization before a coverage determination may be made. Some of the factors that may be used in making a determination include:

  • Diminished ability to carry out activities of daily living
  • A level of visual acuity of 20/50 or worse
  • Significant improvement can be expected as an outcome of the surgery

Cataracts can affect your perception of colors and light, cause double vision, blurred or cloudy vision, seeing halos around lights, and increasing difficulty seeing at night.

Aetna Medicare Advantage plans like all Medicare Advantage plans are required by law to cover at least as much as Original Medicare covers. Because Original Medicare covers cataract surgery if its performed using traditional techniques or using lasers, Medicare Advantage plans will offer at least that same level of coverage, if not more.

Most Medicare Advantage plans offer additional benefits that Original Medicare doesnt cover, such as prescription drug coverage, dental, hearing, transportation and more.

Aetna Medicare Advantage plans that include vision benefits typically cover routine vision care, eyeglasses or contact lenses, eye exams and more.

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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.

What Other Vision Benefits Does An Aetna Plan Include

How Much Does Medicare Advantage Pay For Cataract Surgery

In addition to cataract surgery, Aetna vision insurance and Aetna Medicare Advantage plans can often include coverage of annual eye exams, glaucoma screenings, eyeglasses and contact lenses and discounts on LASIK eye surgery.

Aetna individual and employer-based plans generally require vision coverage to be added on as a standalone benefit. In Aetna Medicare Advantage plans, vision benefits are usually included at no extra cost.

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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.

Cataract Surgery And Medicare

Now that you know a little more about Medicare and cataracts that dont require surgery, lets take a look at surgical options.

Cataract surgery is a simple procedure that involves replacing the natural lens in the affected eye with an artificial one. If you have cataracts in both eyes, youll likely have it performed on one eye at a time.

Since cataract surgery is typically performed on an outpatient basis, its covered under your Medicare Part B benefits. Medicare Part B also covers:

  • Eye exams to diagnose serious vision problems
  • Pre-surgery eye exams
  • One pair of prescription eyeglasses or contact lenses after surgery
  • Up to one year of follow-up care

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Original Medicare Medicare Advantage And Medigap Offer Different Coverages

Once youve met your deductible, Medicare Part B will cover 80% of the cost of your surgery. Though its rare for hospitalization to be required for this type of surgery, if its deemed necessary, Medicare Part A will cover it as well.

Medicare Advantage and Medigap supplemental insurance may also offer lower out-of-pocket costs and encompass more elaborate treatments for you, though its likely that your choice of providers will be limited under these plans.

Will Medicare Cover My Cataract Surgery

The Use of Glasses After Cataract Surgery with Dr Graham Fraenkel

Yes, Medicare will cover your cataract removal surgery, but only if your doctor considered the procedure medically necessary. In regards to cataract surgery coverage, Medicare will cover the pre-exam surgery, the surgery itself, and the surgical anesthesia.

Patients who undergo medically necessary cataract removal will need to pay 20 percent of the Medicare co-insurance for the procedure as well as their Medicare deductible.

If cataract removal is not medically necessary, then Medicare will not cover the procedure.

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Does Aetna Cover Laser Cataract Surgery

You would need to check with your Aetna plan directly to confirm whether coverage of cataract surgery extends to laser techniques.

Original Medicare covers the use of lasers, which means Aetna Medicare Advantage plans cover laser cataract surgery as well. Laser surgery, however, could potentially come with higher out-of-pocket costs for a beneficiary than traditional surgical techniques. Be sure to check with your doctor and your insurance plan carrier.

Your Aetna insurance or Aetna Medicare plan may have its own restrictions and conditions regarding the use of lasers or premium lenses.

Does Medicare Advantage Cover Cataract Surgery

Medicare Advantage covers everything that Original Medicare covers , and it does cover cataract surgery. As with many other medical services, a Medicare Advantage plan may offer lower out-of-pocket costs for cataract surgery. But Medicare Advantage may also limit available providers to those within its network. Copays, coinsurance and deductibles vary by plan, so contact yours for details.

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Does Medicare Cover Vision And Glasses

Original Medicare does not cover routine vision exams or glasses, but Part B helps cover certain vision-related services if you have eye disease or injury.

Medicare Advantage Plans, an alternative to Original Medicare, provide the same coverage as Part B, plus more. Most MA plans offer some coverage for routine eye exams and corrective lenses.

Part B vision care coverage is limited to medically necessary treatment for your eye problems. Some of the eye conditions covered by Part B may be a common and normal part of aging and are considered to be Medicare-covered services. MA plans include all Medicare-covered services plus some non-covered Medicare services, such as routine eye exams and financial allowances for corrective lenses.

Does Medicare Cover Specialized Eye Treatments

What Does Medicare Cover For Glasses And Lenses After Cataract Surgery

Medicares eye health coverage varies based on whether or not you have certain conditions. For example, Medicare Part B covers eye exams for diabetic retinopathy once a year if you have diabetes.

If youre at high risk for glaucoma, Medicare Part B will cover tests every 12 months. Certain diagnostic tests and treatment for age-related macular degeneration also are covered.

With Original Medicare, Part B deductibles will still apply and you will pay 20% of the Medicare-approved amount for these services. In a hospital outpatient setting, you would pay a copay.

LOOKING FOR AN EYE DOCTOR WHO ACCEPTS MEDICARE? Book an appointment with a local eye doctor near you.

Page published on Saturday, February 29, 2020

Page updated on Wednesday, March 16, 2022

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When Does Original Medicare Cover Eye Exams

Eye exams may be covered for Medicare beneficiaries who have certain medical conditions. Coverage is under Medicare Part B. Your provider must accept assignment, the Part B deductible applies, and your out-of-pocket cost is 20 percent of the Medicare-approved amount. If you receive services as a hospital outpatient, your out-of-pocket may also include a copayment in addition to your 20 percent Part B coinsurance.

The following vision care is covered by Medicare Part B:

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.

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How Much Does Medicare Cover For Cataract Surgery

Medicare specifically covers these parts of cataract surgery services:

  • Removal of the cataract
  • One set of prescription eyeglasses or one set of contact lenses after the surgery

Medicare covers basic lens implants only. Medicare does not cover more advanced implants.

Important to note:If your provider recommends more advanced lens implants, you may have to pay some or all of the cost. Talk with your health care provider before surgery to understand which costs you will be responsible for, and which costs will be paid by Original Medicare or your Medicare Advantage plan.

Whether you have Original Medicare or Medicare Advantage, here is a breakdown of Medicare billing and coverage for the costs associated with cataract surgery:

  • Medicare Part B would cover your outpatient surgery center costs. This includes doctors fees and other expenses associated with outpatient surgery.
  • Once you meet your Medicare Part B deductible, Medicare pays 80% of allowable charges.
  • Medicare Part A would cover your hospital stay if the cataract surgery takes place in a hospital rather than an outpatient facility. The Medicare Part A deductible would need to be paid if your cataract surgery requires an inpatient stay.
  • Medicare Part D would cover any drops and other medications you are prescribed before and after the cataract surgery.
  • Does Medicare Cover Eye Prostheses

    Medicare Coverage – Medicare Vision Coverage: Does Medicare cover Cataract Surgery

    Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defect, trauma or surgical removal. Medicare covers polishing and of the artificial eye, and typically covers replacement every five years.

    You pay 20% of Medicare-approved amounts after the Part B deductible is applied.

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    Medicare Advantage Plans May Cover Prescription Sunglasses

    Medicare Advantage plans may offer vision coverage including eyeglasses, contact lenses and prescription sunglasses. It may also include vision benefits such as coverage for routine eye exams. Each plan will be different, and youll need to talk with the provider about which eye health items are offered within a plan and how costs are covered.

    Want More Information About Medicare Coverage For Cataract Surgery

    As you can tell, you have several choices if you need cataract surgery and are concerned about coverage. If youd like help finding a Medicare Advantage or Medicare Supplement plan that may help with cataract surgery costs, I am happy to help you understand your options. If youd prefer a phone call or email with personalized information, click the corresponding link below to do that. The Compare Plans button will show you information about plan options you may be eligible for.

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    Other Coverage Options For Eyeglasses

    There are several organizations that can help with the costs of your eyeglasses and vision care. Some examples include:

    • EyeCare America. This is a service from the American Academy of Ophthalmology that partners with area volunteer eye doctors to provide eye exams. However, this organization doesnt provide eyeglasses.
    • Lenscrafters Foundation: OneSight. This foundation has provided more than 10 million eyeglasses to those in need since its founding.
    • Lions Club International. This nonprofit organization provides free eyeglasses to those in its member communities. Contact your local Lions Club chapter to find out more.
    • Medicaid. Medicaid is a state-based government program that helps pay for healthcare and other services for those in need. While Medicaid coverage may vary state by state, many programs pay for a pair of eyeglasses and lenses once every 5 years.
    • New Eyes for the Needy. This is another nonprofit program that helps provide eyeglasses for those in need. Visit its website to see if you may qualify.

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    While it doesnt offer the comprehensive coverage of vision insurance, Medicare can provide coverage for medically necessary vision care, often for patients with certain health conditions like diabetes or glaucoma.

    In this article, Ill discuss what type of eye exams Medicare covers, cataract surgery coverage, and how to find eye doctors that accept Medicare.

    FYI: Often, vision coverage is pretty affordable. Read my picks for dental and vision insurance for seniors to learn more.

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    How Do I Qualify

    If youre 65-or older and your doctor has determined surgery for your cataracts to be medically necessary, Medicare will typically cover 80% of your expenses including post-surgery eyeglasses or contacts.

    While coverage often varies from region-to-region and between local carriers, so as long as your doctor accepts Medicare as payment, youre covered for cataract surgery.

    Medicare Part B Will Cover Corrective Lenses Under One Condition

    If you haveto get cataract surgeryto implant an intraocular lens, Medicare Part B will help pay for corrective lenses. Part B will provide coverage for one pair of eyeglasses with standard frames or a single set of contact lenses, and you will pay 20 percent of the Medicare-approved amount for the lenses after each surgery. The Part B deductible will also apply.1

    Coverage for lenses and glasses is limited outside of a Medicare Advantage plan so consider your eye health needs carefully when choosing Medicare coverage.


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    Medicare And Cataract Surgery

    Medicare typically covers cataract surgery if a physician deems it medically necessary. Since Original Medicare consists of both Medicare Parts A and B, a majority of the coverage will come from Part B as long as the deductible is met.

    Under Part B or outpatient insurance, Medicare will pay 80 percent of the cost of cataract surgery as well as the cost of eyeglasses or contact lenses post-surgery. You will owe 20 percent of the Medicare-approved amount.

    If you have a Medicare Advantage plan, your private carrier will pay for your medical costs instead of Medicare. Private insurers must offer benefits as good as Medicare, but the benefits are not standardized. Each plan has its own summary of benefits, so youll need to contact your carrier directly to find out how much it will cover and how much youll have to spend out of pocket.

    If you have a Medigap plan, the 20 percent coinsurance under Part B will be covered. Medigap will always pay the leftover coinsurance under Part B as long as Medicare pays its portion.

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