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Does Medicare Cover Cataract Surgery?

Cataracts are rarely dangerous, but they do affect your vision. According to the National Eye Institute, around 50% of adults have a cataract or have undergone cataract surgery by the time they reach 80.

What does Medicare cover for Cataract surgery?

Original Medicare does not cover vision services; however, Medicare does cover both traditional and laser cataract surgeries. The simple requirement is that the doctor must deem cataract surgery as medically necessary, and the treating physician has to accept a Medicare plan as payment. Typically, Medicare pays 80% of the expenses of the surgery and your Medicare supplement plan will pick up the 20%. Medicare will also pay for one pair of glasses after the surgery. If you have a Medicare Advantage plan, check your plan for details regarding the copays. 

Cataract surgery can range from $2,700 for one eye to just over $5,200 for 2 eyes. However, it can vary and you should always talk to your provider. It will depend on the type of procedure and whether the surgery will take place in an outpatient center or a hospital. Surgeon fees can vary, and the type of lens implant will affect the price. Therefore, it is best to discuss all options with your doctor or surgeon before the procedure. 

Just How Much Will Medicare Cover?

Usually, Medicare pays 80% of the total surgical costs, as long as your doctor deems it necessary. Medicare will cover the following:

·        Preoperative exams

·        Removal of the cataract

·        Implantation of the lens

·        Postoperative exams

·        One pair of prescription eyeglasses or contact lenses after the surgery

Your Medicare Part A covers inpatient hospital stays, which typically are not required for cataract surgery. However, if there are complications your Part A will cover hospital costs.

Your Medicare Part B covers all the medically necessary procedures, including the surgery and post-surgical costs. Medicare does not cover prescription eyeglasses, the one exception is Medicare will pay for either a pair of glasses or contact lenses after your cataract surgery.

Estimating your cost: How much will you pay versus what Medicare and your secondary Medicare plan pay?

  • Does your provider accept Medicare and Medicare assignment? 
  • Does your provider accept your Medicare Advantage plan?
  • Will the procedure be performed in a standalone surgical center or at hospital outpatient facility?
  • What will be the doctor fee for the procedure? How much are you expected to pay based on your Medicare plan. 
  • What other costs should I expect after the surgery? You need to consider prescriptions such as eye drops. 

 Medicare: Are there exclusions?

Medicare covers traditional and laser cataract surgery. Medicare may not cover all types of intraocular lens. As an example, Medicare does not cover New Technology Intraocular Lenses (NTIOLS).  Some toric lenses, designed to correct astigmatism, may not be fully covered. Discuss with your eye doctor whether it makes sense for you to pay more (out-of-pocket) for the potentially greater improvement in vision.

Do you have any other questions on Cataract Surgery?

Call Senior HealthCare Solutions and we will help you determine your costs based on your plan.

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Meet Melissa MacCalla

Medicare is not simple and can be hard, frustrating, and downright confusing for most. I love when I get someone on the phone and I am given the opportunity to explain the difference in plans to them and have Medicare make sense. I enjoy talking to clients year after year, hearing about their families growing or them asking about mine.

-Melissa

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