Thursday, April 11, 2024

Does Medicare Pay Cataract Surgery

How Do I Know If I Need Cataract Surgery

Medicare – Will it Pay For Cataract Surgery?

In the early stages, a cataract may be treated with:

  • Eyeglasses or magnifying lenses
  • Environmental adjustments
  • Anti-glare sunglasses

If the above solutions arent helping and your vision is impairing your everyday life, you may need cataract surgery.

During cataract surgery, your doctor will remove the cataract from your lens and replace the cloudy lens with an artificial lens. The operation lasts about an hour your doctor may recommend that you remain awake for the procedure, although in some cases, you may have general anesthesia. Most people go home from surgery the same day, although youll need to arrange to have someone take you home. You may need new prescription glasses or contact lenses once your eye heals.

Does Medicare Cover Cataract Surgery

In general, Medicare covers traditional cataract surgeries if they are medically necessary and the treating doctor accepts Medicare for payment.

About 50% of adults have cataracts or have undergone cataract surgery by the time they reach 80 years of age.

Typically, Medicare Part B which is outpatient insurance pays 80% of the expenses related to cataract surgery. This includes one pair of glasses following the surgery.

If cataract surgery requires a hospital stay, Medicare Part A which is hospitalization insurance will cover it. Medicare Advantage, or Medicare Part C, plans provide the coverage of parts A and B.

This article explains the costs of cataract surgery and which expenses Medicare will and will not cover.

According to the American Academy of Ophthalmology, aging is the most common cause of cataracts. Normal proteins in the lens start to break down as a person becomes older. Over time, this breakdown causes cloudiness in the lens, which can interfere with vision.

As of 2015, researchers estimate that about 3.6 million people in the United States undergo cataract surgery every year.

Since surgeons generally perform cataract surgery on an outpatient basis, it falls under Medicare Part B. This covers certain post-surgical costs. Usually, Medicare pays 80% of the total surgical cost, consisting of the procedure itself and the facility charges.

The plan covers the following services:

Does Medicare Cover Laser Cataract Surgery

The short answer to this question is yes.

Medicare will cover your cataract surgery, regardless of the method used. So, whether the surgery is performed using a laser or a more traditional technique, the only thing that matters regarding your coverage is which procedures are performed. This means that if youre going to undergo a laser cataract surgery, you will still receive the same coverage.

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If You Have A Medicare Advantage Plan

Medicare Advantage plans, insurance plans offered by private insurance companies, combine Part A and Part B benefits. Medicare Advantage plans often cover services that Original Medicare doesnt, including vision care. Depending on your health-care needs, these plans may be the best Medicare option for you.

Cataract surgery is typically covered by Medicare Advantage plans, but how much you have to pay out of pocket is based on your premium, deductible, and coinsurance or copayment amount.

What Does Medicare Cover For Cataract Surgery

Does Medicare Pay for Cataract Surgery?

Medicare covers these elements of cataract surgery:

  • The removal of the cataract: This may be done with traditional techniques or lasers.

  • Basic lens implants: Medicare covers only conventional monofocal lenses that improve eyesight at one distance.

  • One set of eyeglasses or contact lenses after the surgery: Medicare covers standard frames only. If you decide to get premium frames instead, Medicare wont pay for the upgrade.

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Cataract Surgery And Medicare Advantage

Medicare Advantage plans are required to cover, at a minimum, the same as Original Medicare. However, MA plans offer several additional benefits like prescription drug coverage, hearing and dental coverage, group fitness classes like SilverSneakers, and additional vision coverage.

Benefits will vary by plan but can include routine eye exams, eyeglasses, contacts, frames, and fittings. These benefits allow you to check your vision each year and update your prescription, lenses, and frames as needed.

If you are only enrolled in Original Medicare, you will need to pay for these expenses out of your own pocket.

Does Medicare Cover Secondary Cataract Surgery

Even after successfully removing a cataract in your eye/s, another one can still reoccur. It can happen again just weeks or months after the cataract-removal surgery.

Though Medicare covers cataract surgery, a common question many people have is, Does Medicare cover secondary cataract surgery? In this article, we answer that question in clear, plain English. You will also find the average costs of secondary cataract surgery, as well as other helpful info.

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Does Aetna Medicare Pay For Eyeglasses

Aetna Medicare Advantage plans are required to cover one set of eyeglasses or contact lenses following a cataract surgery. This coverage requirement is in line with federal law that mandates Medicare Advantage plans meet the benefit minimums set forth by Original Medicare.

In addition to covering a set of eyewear after cataract surgery, many Aetna Medicare Advantage plans also cover prescription eyeglasses and contact lenses on a regular or annual basis. This usually includes an annual reimbursement of a set dollar amount to apply toward a new set of eyeglasses or contact lenses.

You will likely need to receive your glasses from an eye doctor or eye care center that accepts Aetna insurance and participates in your plan.

Does Medicare Cover Other Costs That Come With Cataract Surgery

Does Medicare Cover Cataract Surgery

Original Medicare doesnt cover eyeglasses or contact lenses in most circumstances. But if you need them after cataract surgery, Medicare Part B pays for one pair of eyeglasses with basic frames or one set of contact lenses

  • Curb alcohol. Drinking to excess can raise the risk of cataracts.

  • Get regular eye exams. Detecting cataracts early can help people take preventive or other steps sooner.

  • Take care of overall health. People with other health problems, like diabetes, should follow their doctors orders for self care.

  • Eat healthy foods. Getting a variety of vitamins and nutrients from a regular diet can help keep eyes healthy.

  • Wear sunglasses. Choose shades that block ultraviolet B, or UVB, light, which may speed cataract development.

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How Much Will Cataract Surgery Cost Without Supplemental Coverage

If you have Original Medicare without Medigap, you will be responsible for 20% of the approved Medicare charges for your procedure after you have met your annual Part B deductible.

Assuming that your cataract surgery will be an outpatient procedure, there are a couple of ways you can try to determine your out-of-pocket costs:

  • Use Medicares tool to look up the price of your procedure. Costs are based on national averages and include facility and doctor fees. Additional costs may apply. For instance, if you have a common and uncomplicated procedure at an ambulatory surgical center, you pay $316 after Medicare pays its portion. The facility costs are higher if you have the same procedure at a hospital outpatient department. In that case, the average patient cost is $524. Note: these costs are for one procedure on one eye.This tool can give you a ballpark dollar amount to work with, but the costs in your area and the complexity of your procedure may be very different.
  • For a more accurate estimate, contact the billing department of your Medicare provider and ask for a cost rundown based on what type of surgery you will have and which type of facility it will be in. They are trained and experienced in billing Medicare and should be able to provide you with fairly accurate information, barring any unforeseen complications that may happen during your procedure or recovery period.You may want to ask these questions:
  • Is Cataract Surgery Covered By Medicare

    In general, Medicare covers cataract surgery but there are some restrictions. Original Medicare, Medigap, and Medicare Advantage plans all include coverage for cataract surgery. However, the level of coverage and your out-of-pocket costs will depend on the type of Medicare plan you have.

    Original Medicare and Medigap plans do not include coverage for medications required before or after the surgery. However, Medicare Advantage plans will typically include prescription drug coverage and routine eye exams.

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    Do Medigap Plans Cover Cataract Surgery

    Medigap or MedSupp plans are supplemental Medicare plans. Like MA plans, these intend to fill in the gaps of Original Medicare coverage. A Medigap policy helps pay extra costs, such as Medicare Part Bs annual deductible, which would help with cataract surgery coverage since the Part B deducible applies.

    Is It Better To Be Nearsighted Or Farsighted After Cataract Surgery

    How Much Does Medicare Pay For Cataract Surgery In 2021

    The new lenses inserted during cataract surgery can correct refractive vision problems such as nearsightedness, farsightedness, and presbyopia. Nearsightedness is when you have trouble clearly seeing things that are far away.Farsightedness is when you have trouble clearly seeing things that are up close.

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    What’s The Best Medicare Advantage Plan For Cataract Surgery

    Medicare Advantage plans unify your Medicare coverage, bringing together Part A, Part B, prescription drug benefits and additional cost-savings for health care.

    These plans are similar to traditional health insurance, and you’ll usually have a copayment for each procedure or type of medical care. If you’re expecting to have a procedure like cataract surgery, choosing a Medicare Advantage plan with low copayments can help keep your costs from piling up for each appointment or procedure.

    Medicare Advantage plans can also be a good tool for managing eye conditions. Plans that include vision insurance can give you routine care from an optometrist as well as access to medical eye care from an ophthalmologist.

    Medicare Advantage plans we recommend

    • Good coverage for prescriptions
    • Vision insurance

    Medicare Cataract Surgery Exclusions

    Whether you have Original Medicare, Medigap, or a Medicare Advantage plan, cataract surgery will be covered. However, there are some exclusions to the coverage depending on the type of plan you have.

    Original Medicare only covers 80% of the total cost of cataract surgery. It also excludes coverage for prescription drugs, copayments, and deductibles.

    Also, depending on your Medicare plan, Medicare may not cover all types of intraocular lenses . Multifocal and toric lenses may not be included in your coverage.

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    Cataract Surgery: Is It Medically Necessary

    Medicare will only cover your cataract surgery if it is deemed as being medically necessary. In the majority of instances, procedures like cataract surgery will be deemed medically necessary. However, it will be useful to make sure that this is the case before you proceed with the surgery. Otherwise, if you discover that Medicare will not pay for it after the fact, it could put you in a real financial bind.

    What Are Other Medicare Coverage Options For Cataract Surgery

    Does Medicare Pay for Cataract Surgery?

    You have other options to help manage your cataract surgery costs. A Medicare Supplement plan may cover all or part of certain out-of-pocket costs, such as your deductibles, copayments, and coinsurance amounts. Many people choose a Medicare Supplement plan, or Medigap plan, to help manage their health-care costs in Original Medicare. Some plans also cover Part B excess charges that may apply these charges are the difference between the amount Original Medicare covers for a given service and what your doctor charges. Youre usually responsible for paying this difference if your doctor charges above the Medicare-approved amount, but some Medicare Supplement plans include benefits that cover these costs.

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    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.

    Why Intermountain Healthcare

    At Intermountain Healthcare, we are dedicated to providing high-quality healthcare in the heart of our communities. Use our Find a Provider tool today to find a doctor close to home and ready to meet with you.

    *Please check with your plan for more information on details of your benefits coverage. This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician or qualified healthcare professional.

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    When Should I See A Doctor

    Cataracts arent always noticeable in their early stages, which is why its best to schedule regular visits with your eye doctor for early detection.

    But, if you do experience any of the following symptoms, its time to visit your doctor:

    • Indistinct differences between colors

    So, does Medicare pay for cataract surgery? Yes, once your deductible and co-payment are met, Medicare can cover the rest and keep your treatment affordable for you.

    How Much Does Medicare Cataract Surgery Cost With No Extra Coverage


    According to Healthcare Bluebook, a fair price for cataract surgery would cost $4,366.1

    Medicare Part B covers 80% of standard surgery once you meet your annual deductible.

    For example, say you need cataract surgery on one eye, and it costs $4,366 for the standard procedure. You would need to pay 20% after you meet your deductible. The table below gives a breakdown of the costs:

    Cataract Surgery
    $233 $1,059.60

    The cost of your surgery will depend on several factors including the type of intraocular lens you get, the technology used, and the surgeon who performs it.

    If you undergo laser cataract surgery, you will likely need to pay the added costs yourself. This is also the case if you receive a premium toric IOL for astigmatism or a presbyopia-correcting IOL.

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    What Are The Symptoms Of Cataracts

    Only a doctor can diagnose cataracts, but if you experience any of the following symptoms, its a good idea to see your doctor:

    • Blurred or cloudy vision
    • Trouble seeing at night

    These symptoms can also occur with other conditions, so be sure to have your eyes checked by your doctor if you are concerned.

    Medicare Part D Coverage For Cataract Surgery

    Medicare Part D prescription drug coverage can help you pay for the prescription drugs you will need following cataract surgery.

    Types of Drugs Typically Prescribed Before or After Cataract Surgery

    Antibiotics are often prescribed to prevent endophthalmitis, a rare but serious complication that can follow cataract surgery along with other bacterial infections. They are prescribed for a few days before surgery until a week or two after.
    These steroids can reduce inflammation caused by the trauma of surgery and the release of lens proteins that can result in a painful, red eye. You usually take these medications for a few weeks following surgery.
    Nonsteroidal Anti-Inflammatory Drugs
    These are anti-inflammatory drugs that work differently and can be used in conjunction with corticosteroids. Many are over-the-counter medications such as aspirin, Advil and Aleve. Other drugs in the class, such as Celebrex, may require a prescription.

    If you have Original Medicare, youll have to purchase a separate Part D prescription drug plan, but these plans are often included in a Medicare Advantage plan. You should check if a Part D plan is included before purchasing a Medicare Advantage plan.

    Some medications related to your immediate surgery may be covered by Medicare Part B, but only if Medicare considers them to be medical, rather than prescription drug, expenses.

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    Find Cheap Medicare Plans In Your Area

    Cataract surgery is covered by Medicare, and how much youll pay for the surgery will depend on which type of Medicare plan you have and the plans coverage level. For those who have Medicare Part B, the average out-of-pocket cost for cataract surgery ranges from $207 to $783.

    One of our top recommendations is to sign up for Medigap Plan G from AARP, which gives you cataract surgery at a $0 copayment, with an average policy costing about $150 per month. You can also get great coverage with the more convenient Medicare Advantage plan from Aetna, which has cheap monthly rates and includes vision insurance.

    What Does Medicare Pay For Cataract Surgery

    My Cataract Surgery? Medicare Co-Pay, Pain Assessment, Benefits. Will Get My Other Eye Done?

    WhileMedicare will pay for cataract surgery, it doesnt cover the costs in full.Medicare covers 80% of your medical costs, including:

    • Ophthalmologist exams and facility charges
    • Pre-surgery exams

    Medicare will not cover the costs of:

    • The remaining 20% of your bill

    In these instances, youll either pay out of pocket, or your other forms of insurance will pick up the costs. For instance, if you have a Medicare Supplement plan, it may cover all of your medical expenses. Your medications would be covered under your Medicare Part D prescription plan. As long as Medicare approves your surgery, your Medicare Supplement plan will pay its portion as well.

    What Type of Cataract Surgery does Medicare Cover?

    Medicare will cover cataract surgery performed manually witha blade, and laser surgery. In addition, Medicare will pay for intraocularlenses for presbyopia or astigmatism, only if they if they need to be placeddue to cataracts.

    Does Medicare Pay for Glasses After Cataract Surgery?

    Medicare will cover your first pair of glasses aftercataract surgery. This is one of the few instances in which vision expenses arepaid for, as they arent usually covered by Medicare.

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