Cataract surgery is a procedure performed by an eye doctor that removes the lens of your eye and replaces it with an artificial lens. The surgery is suggested when cataracts cause your lens to cloud, making your vision blurry and daily activities difficult.
Original Medicare (Part A and Part B) doesn’t include vision insurance. So if you have cataracts, you will likely think you need to pay out of pocket for surgery.
However, Original Medicare does pay for cataract surgery. The government considers cataract surgery medically necessary, so it’s covered. Continue reading to learn more about what is covered and how much you should expect to pay.
What Does Medicare Cataract Surgery Coverage Include?
Original Medicare covers an intraocular lens replacement, facility and doctor services during the surgery, and one pair of prosthetic eyeglasses or contact lenses. It also covers postoperative complications that are addressed in the office.
A basic cataract procedure involves the surgeon using a blade to remove the lens. The surgeon then replaces it with a monofocal lens that replaces the cloudy lens but doesn’t enhance your vision. Subsequently, you might still require contacts or glasses after cataract surgery.
However, it is possible to upgrade your surgery by paying the additional costs out of your pocket. For instance, you can get bladeless surgery and multifocal lenses, so you don’t require glasses or contacts. You will pay the remaining balance after Medicare pays for the standard procedure. Before moving forward, talk to the provider to find out exactly how much the out-of-pocket costs will be.
How Much Is Cataract Surgery With Medicare?
According to www.medicare.gov, cataract surgery at a surgical center costs about $1,789 ($750 in doctor fees and $1,039 in facility fees). Medicare will pay $1,431 of that total, which means the patient pays $357. (source)
Cataract surgery in a hospital’s outpatient department costs $2,829 ($750 in doctor fees and $2,079 in facility fees). Medicare pays $2,263, so the patient pays $565. How much of your cataract surgery is covered with Medicare wholly depends on your plan, out-of-pocket cost structure, and Medicare provider. (source)
Which Medicare Parts Cover Cataract Surgery?
Medicare Part B pays for the fees associated with cataract surgery. However, you must pay your Medicare Part B coinsurance and the deductible. The deductible usually goes up slightly from one year to the next.
Original Medicare covers 80% of the cost of cataract surgery, while patients pay the remaining 20% (either out-of-pocket or with supplemental insurance) after meeting their Part B deductible.
Many people can reduce out-of-pocket costs while improving coverage by choosing the Medicare Advantage (Medicare Part C) Program. The program allows for additional private plans on the insurance marketplace and provides the same benefits as Medicare, although most include extras. For example, you might be eligible for different lenses and types of cataract surgery under the Medicare Advantage Program. Reading the fine print to determine what is covered and your out-of-pocket costs is essential.
How to Apply for Medicare Plans With Cataract Surgery Coverage
Firstly, you will want to book a consultation with an ophthalmologist, as a doctor typically gives estimates based on a patient’s needs and treatment options. You can apply for Medicare during the annual open enrollment period, which begins on October 15th and ends on December 7th.
Does Medicare Continue Vision Coverage Post-Surgery?
After your cataract surgery, Medicare Part B will pay for either one pair of eyeglasses or one set of contact lenses from suppliers enrolled in Medicare. You pay 20% of the approved charges and have most likely already met your Part B deductible for your surgery.
Medigap will cover the Part B 20% cost, and Medicare Advantage plans cover standard frames or one set of contact lenses just like Part B. You will be responsible for the cost of any upgrades to your post-surgery glasses, like frames or progressive lenses.
Things To Discuss With Your Doctor Before Cataract Surgery
Before your cataract surgery, you should ask your doctor as many questions as you’d like, including:
- Will I experience complications?
- Who will be performing my surgery?
- Who will I be seeing for my post-op visits?
- Will I have to use eye drops after surgery?
- Will I have to wear an eye patch after surgery, and for how long?
Additionally, it would be best if you discussed some questions with your eye doctor before any procedure, including:
- Which hospitals or surgical centers do you work with?
- Which facility is best for me?
- What should I do if I have a medical emergency at a surgical center?
- Does Medigap require me to get a referral before cataract surgery?