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Does Medicare Pay For Cataract Surgery

Which Medicare Plans Offer Cataract Surgery Coverage

Does Medicare Cover Cataract Surgery?
  • Original Medicare, which includes Part A and Part B , offers cataract surgery coverage. This procedure most often takes place in an outpatient setting, such as an ambulatory surgery center, or a hospital outpatient department, both of which fall under Part B benefits. Part A coverage would only apply if the surgery is done in a hospital.
  • Medicare Supplement Insurance plans help cover the out-of-pocket costs you incur when you access your Original Medicare benefits. For instance, if your cataract surgery takes place in an outpatient setting , Part B will pay for 80% of approved Medicare charges after you satisfy your annual deductible. Most Medigap plans will cover the other 20%. You will still be responsible for the Part B annual deductible and your Medigap monthly premium.
  • Medicare Advantage plans, as an alternative to Original Medicare, also cover cataract surgery. MA plans provide the same benefits as Original Medicare does, so if a service is covered under Original Medicare, in this case, cataract surgery, it is also covered under a MA plan.

Both MA plans and Medigap plans are approved by Medicare and are offered by private insurance companies. You cannot have both at the same time.

With Original Medicare, you are responsible for 20% of the Medicare-approved charges after you satisfy your annual Part B deductible . Part B covers 80%.

Should I Pay Out Of Pocket For Cataract Surgery

In conclusion, if you want to be able to do more visual tasks without constantly having to reach for your glasses, you don’t have any other significant visual disease and the costs your surgeon is charging for the additional services are within your ability to pay then, yes, you should consider paying extra when you

What Services Does Medicare Cover For Cataract Surgery

Medicare covers a basic version of cataract surgery, performed by hand, with a basic lens implant, that is not customized to your eyes. It also covers 90 days of routine follow-up care. Some of the other things it typically covers:

  • Pre-operative eye exam to diagnose your cataracts
  • Limited pre-operative measurements for basic lens implants
  • Anesthesia during surgery
  • Contribution to one pair of prescription eyeglasses after surgery
  • 90 days of follow-up care for issues related to the procedure

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Does Medicare Cover Other Costs That Come With 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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What Does Cataract Surgery Cost

Does Medicare Pay for Cataract Surgery?

Thereare two main kinds of cataract surgery. Medicare covers both surgeries at thesame rate. These types include:

  • Phacoemulsification. This type uses ultrasound to break up the cloudy lens before it is removed and an intraocular lens is inserted to replace the cloudy lens.
  • Extracapsular. This type removes the cloudy lens on one piece, and an IOL is inserted to replace the cloudy lens.

Your eye doctor will determine which type of surgery is best for you.

According to the American Academy of Ophthalmology in 2014, the general cost of cataract surgery in one eye with no insurance was approximately $2,500 for the surgeons fee, the outpatient surgery center fee, the anesthesiologists fee, the implant lens, and 3 months of postoperative care.

However, these rates will vary by state and the specifics of an individuals condition and needs.

The exact cost of your cataract surgery will depend on:

  • your Medicare plan

cost of cataract surgery with medicare

An estimated cost of cataract surgery may be*:

  • In a surgery center or clinic, the average total cost is $977. Medicare pays $781, and your cost is $195.
  • In a hospital , the average total cost is $1,917. Medicare pays $1,533 and your cost is $383.

*According to Medicare.gov, these fees dont include physician fees or other procedures that may be necessary. They are national averages and may vary based on location.

Medicare covers basic cataract surgery including:

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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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Changes To Medicare Coverage For Cataract Surgery In 2022

In 2022, Medicare is expected to expand its coverage of cataract surgery. According to the Centers for Medicare & Medicaid Services , Medicare Part B will cover the cost of laser cataract surgery and multifocal IOLs. This expansion of coverage is intended to give patients more options when it comes to cataract surgery and reduce the overall cost of the procedure.

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Financing Your Cataract Surgery

Typically, cataract surgery is covered by insurance and Medicare. However, in the event that your procedure is not fully covered, or if you elect to choose an upgraded lens option as part of your treatment plan, NVISION® offers financing options to ensure that you are not inhibited by cost. Read on to learn more about CareCredit® and see how cataract surgery can be affordable.

What Are The 3 Types Of Cataract Surgery

Medicare – Will it Pay For Cataract Surgery?

3 Main Types of Lens Implants for Cataract Surgery

  • Monofocal lens. These are the standard types of IOL implants used for patients who are having cataract removal. …
  • Toric lens. Toric lens are designed to correct the for nearsightedness with astigmatism or farsightedness with astigmatism. …
  • Multifocal and Accommodating lenses.

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Can You Get Help Paying For Cataract Surgery

Yes. Since Medigap plans help supplement Medicare, they can pay for Medicare fees usually passed on to the patient. Those with Medigap plan G would still pay the Part B deductible but would not have to pay the 20% coinsurance . If you are interested in learning more about how to purchase Medigap, please visit our Medigap overview page or get a quote by clicking the button below.

Medicare Advantage plans all include some coverage for cataract surgery. However, the level of coverage and your out-of-pocket costs will depend on the type of plan you are enrolled in.

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What Is Cataract Surgery

Cataract surgery is a procedure in which a doctor will remove the cloudy lens from an individuals eye and replace it with an artificial lens. This is referred to as an intraocular lens . The surgery usually lasts only an hour and is pain-free.

Cataract surgery is recommended for those with cataracts that impair everyday activities such as driving, reading, or watching television.

There are three main types of cataract surgery include phacoemulsification, extracapsular, and laser.

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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

What Does Medicare Pay For Vision Care

How Much Does Medicare Pay For Cataract Surgery In 2021

Medicare generally doesnt pay for vision care or cover routine eye exams for eyeglasses or contact lenses, which means you are responsible for 100 percent of the cost. There is one exception though: Medicare Part A may cover vision care for patients admitted to the hospital when their vision is deemed a medical problem.

Medicare Part B covers cataract removal since its deemed medically necessary. This coverage also includes artificial lenses and products to correct vision, such as prescription glasses with frames. Individuals typically pay 20 percent of the Medicare-approved amount for vision care items such as glasses or contact lenses after their cataract surgery. Medicare Part B covers some vision care, but it doesnt cover vision exams or eye refractions.

Medicare Part B also covers a set of contact lenses and prescription eyeglasses needed after cataract surgery. Medicare covers intraocular lens implants for cataract surgery, but advanced implants are generally not covered. Medicare Part D, or prescription coverage, may cover certain vision-care products, such as prescription eye drops or other vision-related prescriptions.

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How Much Does Medicare Pay For Cataract Surgery In 2022

Asked by: Prof. Reginald Daugherty DVM

Under Medicare’s 2022 payment structure, the national average for allowed charges for cataract surgery in outpatient hospital units is $2,079 for the facility fee and $548 for the doctor fee for surgery on one eye. Of the $2,627 total, Medicare pays $2,101 and the patient coinsurance is $524.

Factors That Affect How Much You Pay

Several factors affect how much you pay for cataract surgery.

Some regions of the U.S. are simply more expensive, and this higher pricing extends to surgery. Confirm that the amount youre paying is consistent with other surgeons in the area.

Different offices offer different levels of aftercare. If your doctor provides extensive follow-up care, this may increase the overall cost of the surgery.

Likewise, technology will affect the final cost. Laser-assisted cataract surgery is typically more expensive than traditional surgery.

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Understand The Relevant Rulings By Cms

John McInnes, MD, JD

Premium IOL is an unofficial term that refers to IOLs that CMS has designated as presbyopia-correcting, astigmatism-correcting, or a combination of the two. IOLs that are not premium are generally referred to as conventional IOLs these are primarily monofocal IOLs that provide distance vision but not near vision or astigmatism correction. Through Administrator Rulings CMS-05-01 and CMS-1536-R, CMS established that cataract surgery that is performed on a Medicare beneficiary and that includes the implantation of a premium IOL is a partially covered service under Medicare. This means that all items and services consistent with cataract surgery and the implantation of a conventional IOL are covered by Medicare and that the premium IOL and the services attributable to the premium IOL are not covered by Medicare and are therefore paid for by the patient.

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Medicare And Lenses After Cataract Removal

Does Medicare Pay for Cataract Surgery?

Normally, Medicare will not cover the cost of glasses or contacts. However, after cataracts have been removed, Medicare will often cover eyeglasses, contact lenses, and intraocular lenses required to restore vision following the surgery.

Patients will need to pay 20 percent of the Medicare-approved amount plus their Medicare deductible.

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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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What Does Cataract Surgery Cost With Medicare

According to Medicare.gov, having cataract surgery at an ambulatory surgical center costs about $1,789 . Medicare pays $1,431 of that total, which means the patient pays $357.

Having cataract surgery with a hospitals outpatient department, on the other hand, costs $2,829 . Medicare pays $2,263 of that total, so the patient pays $565. These estimates vary based on where you live and the complexity of your cataracts.

The cost of cataract surgery with Medicare Advantage varies widely based on your specific plan. Contact a customer service representative with your provider to discuss what you can expect to pay before undergoing the procedure.

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Does Medicare Cover Glasses

Normally, Medicare does not cover routine vision correction, but Medicare does cover eyeglasses, contact lenses, and intraocular lenses following surgery to treat cataracts.

If you require eyeglasses, Medicare Part B only provides coverage for standard frames. For more expensive frames, youâll pay the difference over the amount approved by Medicare. Ask your doctor what frames are covered by Medicare.

Make sure your supplier is enrolled in Medicare and has a Medicare supplier number because Medicare wonât pay your claim if your supplier doesnât have a Medicare supplier number.

Youâll pay 20% of the amount approved by Medicare , plus your Medicare deductible. Remember to tell your doctor to send the bill for your eyeglasses or contact lenses to Medicare.

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What Are The Requirements For Cataract Surgery

What Will Medicare Pay For Cataract Surgery

In order to receive Medicare covered cataract surgery, you must first have your doctor deem it a medical necessity to receive the procedure. Your healthcare provider will state that at least one of the following conditions in occurring, with some being more serious than others:

  • Cataract symptomatic: When the beneficiary needs medical attention due to visual impairment not correctable with a change in glasses or contact lenses and therefore affecting things like reading, viewing television, and driving.
  • Intraocular disease: When the beneficiary has diabetic retinopathy or an intraocular tumor, and requires monitoring or treatment that is prevented by the presence of cataract.
  • Lens-induced disease: Endangers the beneficiary of vision loss or ocular health, and can include phacomorphic or phacolytic glaucoma.
  • High probability of accelerating cataract development as a result of a concomitant or subsequent procedure
  • Cataract interfering with the performance of vitreoretinal surgery.
  • Intolerable anisometropia or aniseikonia that is uncorrectable with glasses or contact lenses that exists as a result of lens extraction in the first eye

Extracapsular cataract removal with insertion of intraocular lens prosthesis, also known as a 1 stage procedure your costs could look like the following:

  • Ambulatory Surgical Center: $320
  • Hospital Outpatient Department: $532

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How Much Will Cataract Surgery Cost

If you have Medicare, you’ll pay 20% or less of the total cataract surgery bill. The surgery may even be free if you have a plan with a $0 outpatient copayment.

On average, those who only have Original Medicare are paying about $200 to $800 out of pocket per cataract procedure. Below are the average out-of-pocket costs for cataract surgery paid by someone who has Medicare.

Cataract surgery procedure
Extracapsular removal with intraocular lens insertion and endoscopic cyclophotocoagulation to decrease eye pressure $488-$783

The cost of cataract surgery varies widely, and how much you pay will vary based on the following factors:

  • Type of facility where you get the surgery done: Costs are lower if you get surgery at a stand-alone surgery center versus an outpatient hospital unit.
  • Type of surgery you have: Medicare covers both traditional and laser surgery, but since laser surgery costs more, it may come with higher out-of-pocket costs.
  • Your Medicare plan: The type of Medicare you have and the plan’s level of coverage also affect how much you’ll pay.

Final Thoughts On Medicare Coverage For Cataract Surgery In 2022

Cataract surgery is a common procedure among older adults, and Medicare offers coverage for those who are eligible. In 2022, Medicare is expected to expand its coverage of cataract surgery, making it more accessible and affordable for those who need it. It is important to understand the coverage provided by Medicare and to explore other sources of funding if Medicare does not cover the cost of the surgery.

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