Medicare does cover surgery for cataracts, but there may be coverage restrictions or copays.
Medicare covers cataract surgery, which affects 68% of Americans over the age of 80. Medicare Part B deductibles and copays apply. There are limitations on coverage for intraocular lenses and new surgical techniques. According to the National Eye Institute, cataract surgery is extremely safe and improves vision for 9 out of 10 patients.
Original Medicare, Medicare Advantage, and Medigap all offer different coverages
Medicare Part B covers 80% of the cost of medically necessary cataract surgery after the Part B deductible is met. If hospitalization is required — and that’s unusual — Medicare Part A pays. A Medicare Advantage or Medigap Supplemental Insurance may be able to offer lower out-of pocket costs for cataract surgery, but could limit the number of providers. For more information, contact the plan.
What are the factors that affect the price of cataract surgery?
You will pay different factors for cataract surgery. This is usually done on one eye. Costs can be affected by the type of surgery performed, the duration of the procedure and any underlying medical conditions.
Patients have the best control over their cost factors. This includes choosing a Medicare plan, any supplemental coverage and where they want to have surgery performed.
How much does cataract surgery usually cost?
Cataract surgery can be performed at an outpatient hospital, even if you have Medicare coverage. It is more expensive than at an ambulatory surgical centre.
Medicare’s 2020 payment system allowed Medicare patients to pay $2,021 per day for outpatient hospital charges and $557 per eye for doctor fees. Medicare paid $2,063 for the facility fee and $557 for the patient copayment. Medicare totaled $2,578.
Because of the different facility fees, standalone surgery centers had significantly lower costs. While the doctor fee was $557, the facility fee was $1.012, which was half the cost of the outpatient hospital procedure. Medicare paid $1256, and the copay was $213 out of the total $1,569 cost.
Patients with complex cases may require multiple doctors. Additional fees might apply. Ask for information from Medicare, doctors and facilities before you go. This will reduce the chance of unexpected bills.
You should ask these questions:
- Is it possible to accept reimbursement under my Medicare plan?
- How much will the doctor charge for this procedure?
- Is the procedure performed at a hospital or standalone surgery center?
- What are the other costs after surgery?
Is Medicare able to pay for other expenses associated with cataract surgery?
In most cases, contact lenses and eyeglasses are not covered by Original Medicare. Medicare Part B covers one pair of glasses with basic frames and one set of contacts if you have cataract surgery.
After you have met the Part B deductible, your copay for corrective lenses is 20%. Fancier frames will cost you more. Corrective lenses suppliers must be Medicare-enrolled.
What coverage exclusions may apply?
Medicare covers traditional and laser cataract surgery. However, Medicare has yet to pay for New Technology Intraocular Lenses. Some toric lenses that correct astigmatism may not be covered. Talk to your eye doctor about whether it is worth paying more for a potentially better vision.
What are the alternatives to cataract surgery?
Some patients can do well with a few simple steps to improve their vision, even if they are in the beginning stages of cataracts. You can improve your vision with brighter lights, anti-glare glasses, magnifying lenses for close work, and current prescription lenses. Surgery is safe and effective for long-term problems when it’s recommended by doctors.