Friday, April 19, 2024

How Much Does Cataract Surgery Cost With Medicare

How Do I Qualify

How much does cataract surgery cost?

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.

Questions For Your Insurance Provider

You should speak in-depth with your insurance provider or Medicare representative before having cataract surgery to understand exactly how much is covered and how much you ultimately may need to pay out-of-pocket.

Terms of policies vary widely from one insurance company to the next. Questions to ask include:

How much is the copay?

In other words, will you be required to pay a certain amount such as 20% of all related costs, even though they are covered by your health insurance?

How much is the deductible?

Many people choose to have a relatively high annual deductible for their insurance coverage to keep monthly fees low.

If you have an annual deductible of $1,000, for example, you will need to pay that amount out-of-pocket before proceeding with the cataract surgery if you haven’t incurred other medical expenses that apply to the deductible.

Does your plan pay for eyeglasses?

If you need glasses following cataract surgery, find out if your coverage includes at least partial payment for a pair. Many insurance companies, including Medicare, offer a partial reimbursement for one pair of glasses in a lifetime after cataract surgery.

Does your cataract surgeon have a special arrangement as a “preferred provider” or equivalent with your insurance company?

This could make a big difference in the amount you are charged for standard cataract surgery, if you aren’t already covered by Medicare.

Is the surgical center a preferred provider or approved by your insurance carrier?

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.

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What Does Medicare Pay For Cataract Surgery

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.

Nonsurgical Cataract Treatment And Medicare

How Much Does Medicare Pay For Cataract Surgery In 2021

There are several nonsurgical cataract treatment options to consider. Some people may delay cataract surgery since cataracts often worsen slowly. Nonsurgical options include wearing sunglasses that block harmful UV rays, investing in new prescription glasses or contacts, making lifestyle changes, and seeking vision correction from an ophthalmologist. All these options are based on your unique situation, so its best to consult a doctor to see whether they advise nonsurgical cataract surgery.

Medicare generally doesnt cover nonsurgical cataract treatments. There is an exception, however, for patients who have undergone cataract surgery and then require nonsurgical cataract treatments. Medicare Part B, for instance, helps pay for corrective lenses on the condition that you are undergoing cataract surgery to implant an intraocular lens. You would receive one pair of eyeglasses with standard frames or a pair of contact lenses. If you have a Medicare Advantage plan, then check whether your plan offers additional benefits for vision.

If you find that nonsurgical cataract treatment does not help your vision, it may be time to consult a doctor about surgical cataract treatment.

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What Are My Options When It Comes To Premium Lens Implants

If you want to consider all your options, its important to know whats available to you. Herschel LASIK and Cataract Institute in Orlando offers the following premium intraocular lens options:

Toric IOLs

Toric IOLs are unique because they are the only IOL thats specifically designed for patients with astigmatism. Astigmatism occurs when the cornea is irregularly curved.

When this happens, your vision will be distorted and blurry. Its also common to have other refractive errors like nearsightedness and farsightedness when you have astigmatism.

Toric IOLs correct astigmatism and provide patients with clear vision after cataract surgery.

Multifocal IOLs

If the concept of needing glasses to see at more than one distance wasnt appealing, multifocal IOLs may sound better. These IOLs restore a full range of vision in both eyes.

This includes near vision, intermediate vision, and distance vision. Multifocal IOLs work because they contain rings with different magnifications which enable a wider range of clear vision.

These rings help the brain pick the right focus automatically. This is something that patients never have to think about since it happens automatically.

There is some adjustment that may be necessary, but most patients get used to their multifocal IOLs quickly.

Aspheric IOLs

Another kind of premium lens to consider is an aspheric IOL. With aspheric IOLs, this lens is the closest to the shape of the natural lens.

What Is The Price Of Cataract Surgery

According to some Trusted Source researchers, prices for one eye range from almost $2,700 to slightly more than $5,200.

On the other hand, the cost of cataract surgery can vary significantly between states and depends on the individuals needs. For example, depending on the treatment and if the surgery is performed in an outpatient surgical center or a hospital, it may cost more.

Individual surgeon costs differ, which can influence the total cost of the surgery. Also, the type of lens implant affects the price of lens implant.

For the most realistic image of the final cost, it is rightest to discuss the expenses with the surgeon.

On the other hand, Medicare will cover 80% of the procedure price, regardless of the cost.

Supplemental health-care insurances position in Medicare

Medicare supplemental plans, commonly known as Medigap plans, are private insurance policies that help consumers pay for the 20% of expenditures that Medicare does not cover.

Supplemental plans, for example, may cover deductibles, copayments, and other out-of-pocket costs. Anyone over 65 with Medicare Parts A and B can apply for a supplemental plan.

Supplemental insurance for Medicare comes at a variety of prices.

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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

Does Medicare Pay For Glasses After Cataract Surgery

Medicare – Will it Pay For Cataract Surgery?

Yes, Medicare will cover one pair of glasses with standard frames or one set of contacts prescribed by your doctor after your cataract surgery is complete. These glasses or contacts must be procured through a Medicare-approved supplier.

To avoid any sticker shock with your new glasses, ask your doctor or health care provider for a list of Medicare-approved frames before making a selection.

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What Are Cataracts And How Do They Affect Vision

According to the National Eye Institute, a cataract occurs when the lens of your eye becomes cloudy. The lens is the clear part at the front of the eye that helps you to focus on an image. When functioning normally, light enters your eye through the lens and passes to the retina, which then sends signals to your brain that help you process what you see as a clear image. When the lens is clouded by a cataract, light doesnt pass through your eye to your retina as well, and your brain cant process images clearly, resulting in blurry vision.

Cataracts can occur in one or both eyes, but they cannot spread from one eye to the other. Your chances of developing cataracts increase significantly with age.

Some people develop cataracts at a much younger age, such as in their 40s or 50s. However, these cataracts tend to be smaller in size and do not usually affect vision. In general, people dont experience vision problems from cataracts until they reach their 60s.

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What Can Increase The Cost Of Cataract Surgery

If you choose to have premium IOLs implanted or a more modern technique used, this can drive up the cost of cataract surgery.

Cataract surgery is commonly covered by both private medical insurance and Medicare up to a point. If you choose to have premium IOLs implanted or a more modern technique used such as laser-assisted surgery, this can drive up the cost of cataract surgery.

Placing a premium lens instead of a basic IOL can help to correct for astigmatism or refractive error. This can then save you money on corrective eyewear, but this will drastically increase the cost of the surgery overall. You will likely need to pay this out-of-pocket, as it will often not be covered through insurance.

If you choose not to wait for the cataract to be bad enough to be covered under insurance, or you do not have insurance coverage for cataract surgery, there are financing options available. Most clinics and eye care centers will offer payment plans or the ability to finance the surgery.

Health savings accounts and flexible spending accounts can also be used to pay for medical expenses that are not covered through insurance. This can include costs associated with cataract surgery.

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Determining Cataract Surgery Cost

Since most people who undergo cataract surgery in the U.S. have Medicare or private medical insurance, it can be somewhat challenging to determine the cost of the procedure for someone with no insurance coverage.

In such cases, many surgeons often charge the same fees for cataract surgery that they charge for an elective vision correction procedure called refractive lens exchange .

Refractive lens exchange is essentially the same procedure as cataract surgery, but the eye’s natural lens that is removed in RLE has not yet become clouded by a cataract. By replacing the eye’s natural lens with an IOL, the surgeon can correct significant amounts of nearsightedness or farsightedness, reducing the patient’s need for eyeglasses or contact lenses.

In 2019, the average cost of refractive lens exchange with a standard monofocal IOL implant was $3,783 per eye, according to a large survey of U.S. cataract and refractive surgeons.

For RLE with a toric IOL for astigmatism, the average cost was $5,304 per eye, and the average cost of RLE with a presbyopia-correcting IOL ranged from $4,704 to $6,898 per eye.

How Does Medicare Cover Vision Services And Treatment

What is the Cost of Cataract Surgery?

Medicare wont pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions.

Q: How does Medicare cover vision services and treatment?

A: Medicare wont pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions.

Regular vision care is important at any age, but its especially crucial for seniors, as theyre more prone to eye disorders and disease. Unfortunately, seniors are by no means guaranteed complete vision coverage under Medicare, so its important to know what to expect.

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What Are The Costs Of Cataract Surgery

For people with original Medicare, the national average price of cataract surgery at an ambulatory surgical center is $1,606. The out-of-pocket cost can be as little as $320.

That said, several factors can affect your personal medical bill. These include:

  • Choice of facility: Surgery at an ambulatory surgical center typically costs hundreds of dollars less than at a hospital outpatient facility.

  • Type of surgery: There are two commonly used techniques for cataract surgery. Phacoemulsification uses a small incision extracapsular cataract extraction uses a larger one. A Medicare beneficiarys average ASC price is $361 for ECCE or $369 for phaco.

  • Type of artificial lens: Medicare only covers one type of IOL: the standard monofocal lens, which provides clear vision at one distance. But there are different types of IOLs. If you choose an advanced multifocal lens , it could cost you thousands of dollars out of pocket.

  • Potential post-surgery expenses: These can sometimes be costly. For instance, retinal detachment is a common complication. For surgery to repair it, a Medicare patients out-of-pocket cost can range from hundreds of dollars to more than $1,000. The total cost depends on the type of procedure.

The Cost Of Cataract Surgery With Or Without Insurance

Cataract surgery costs an average of $3,500 and can range up to $7,000 per eye.

Both private insurance companies and Medicare can cover the majority of the costs associated with cataract surgery. You can still incur some out-of-pocket expenses, depending on your specific plan, carrier, and policy.

More than half of all American adults ages 80 or older have, or have had, cataracts. Cataract surgery is one of the most common surgical procedures in the world. It is typically deemed medically necessary once the cataract is interfering with daily life tasks, such as driving, reading, or watching television.

Cataract surgery is the only treatment for cataracts. It is considered a safe and effective method for improving eyesight related to cataracts.

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Private Medical Insurance And Cataract Surgery Costs

Like Medicare, medical policies sold by private insurance companies typically cover only cataract surgery services and related products and services that are considered “medically necessary.” The extra cost of a premium IOL typically is not covered, so you must pay the added cost of the lens out-of-pocket. Again, the same applies to laser cataract surgery the additional cost is not covered by insurance.

Also, co-payments and deductibles often are required. Contact your plan administrator or insurance agent for details.

In many cases, private cataract surgeons have staff members who are very knowledgeable about insurance matters and can provide you with comprehensive information about your cataract surgery cost and what your insurance policy does and does not cover.

Does Medicare Cover Eye Prostheses


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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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 Vision Care

Generally, Medicare does not cover vision care. However, Medicare does cover medically necessary services. What does that mean? Cataract surgery that is deemed by a physician as medically needed, falls into this category. With Original Medicare, cataract surgery services are typically covered under your Part B portion of Medicare.

Different parts of Medicare cover different areas of medical expenses. If you need a refresher on the parts of Medicare, be sure to check out our video that explains it all.

As a reminder, Medicare Part B insurance covers outpatient services. If you have a Medicare Advantage plan, they should cover the same services as Original Medicare but may have different costs and conditions. We know, its confusing! Therefore, if you are on a Medicare Advantage plan, it is very important to contact your plan representative for your specific costs and coverage of cataract surgery. They will know exactly what is covered and what isnt.

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How Do Progressive Lenses Work

So, how do progressive glasses work? Progressive lenses allow you to see at all distances with one pair of glasses. They start with your distance prescriptions at the top of the lens and increase as you move toward the bottom of the lens. You can move your head position to allow you to focus through different areas of the lens.

Move your head upwards to see something in the distance, and hold it straight for intermediate or arms length vision and down for near vision for objects that are close up. Apart from the aesthetic improvement of the lens without the line segments, progressive lenses avoid the visual discontinuity or image-jump when your eyes shift from one zone to the other in non-progressive multifocals.

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