Does Medicare Cover Cataract Surgery?

Does Medicare Cover Cataract Surgery?

Does Medicare Cover Cataract Surgery: Complete Guide on Cataract Ery Surgery Cost, Medicare Surgery Coverage, and Benefits

A cataract is a cloud in your eye that makes it hard to see which according to the American Eye Institute, more than half of all Americans who are age 80 or older are either living with cataracts or have had surgery to get rid of them.

Cataracts can happen slowly, but eventually, you will not be able to do the things you used to be able to navigate through life:

Getting into bed and undressing; driving or riding a bicycle; reading the text under certain lighting conditions.

Cataracts are typically caused by age-related changes in an aging lens within the eye, which affects light transmitting inward from outside of the body and visible images formed on its surface.

Cataracts typically affect both eyes and can be treated by either surgery or laser treatment, although the latter is often reserved for those who have a greater risk of complications from surgery.

Yes, Medicare does cover cataract surgeries as long as you meet certain criteria. In this article, we will do a deep dive into Medicare and the best way to receive your Medicare benefits related to cataract surgery.

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Table of Contents

Does Original Medicare, Medicare Advantage Plans, and Medigap Plans cover the Cost of Cataract Surgery?

Original Medicare and Cataract Surgery:

Cataract surgery is covered by Original Medicare Part B. This means that you will generally have to pay 20 percent of the approved amount for the surgery, as well as a Part B deductible, and a copay if you do not have a Medicare Supplement plan.

Medicare Advantage Plans and Cataract Surgery:

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies that contract with Medicare.

These plans must cover all of the benefits that Original Medicare covers (80 percent of the costs). Depending on how your Medicare Advantage plan covers cataract surgery costs will depend on how much a Medicare Beneficiary will be obligated to pay.

Cataract surgery is typically covered by Medicare Advantage Plans. You will usually have to pay a copayment and/or coinsurance for the surgery, and your exact costs will depend on the specific plan you have.

Medicare Advantage plans are required to have max out-of-pocket costs, so depending on your plan your costs can be between $500 to $7,550 for the 2022 plan year.

Medigap Policy and Cataract Surgery:

If you have a Medicare Supplemental Policy, it will cover up to 100% of the costs of your Original Medicare coverage. This means that it can help you pay for things that Medicare doesn’t cover, such as the 20% coinsurance, deductibles, and copays for cataract surgery.

How Much Will Cataract Surgery Cost?

How Much Will Cataract Surgery Cost?

Costs of Cataract Surgery with Original Medicare ONLY

Cataract surgery is a common procedure that can improve your vision. However, it is important to know the cost before you decide if it’s a good option for you.

The cost of Cataract Surgery with Original Medicare ONLY is on average around $1,600 per eye in an outpatient treatment facility.  This means you would be responsible for 20 percent of this cost. Prices may change over time, so be sure to check this heading regularly for updated information.

Costs of Cataract Surgery with a Medigap Policy

Cataract surgery can be expensive, and many people choose to take out a Medigap policy in order to cover the cost. A Medigap policy is like other types of health insurance, but it covers more than just healthcare costs. Medigap policies also cover expenses like doctor visits, prescription drugs, and hospital stays.

Before choosing a Medigap policy, make sure you understand the coverage that is offered by each company. Some companies offer comprehensive coverage while others focus on specific areas, such as vision care or dental care. It’s important to choose a policy that meets your needs and covers the costs of cataract surgery.

Most policies are effective starting the day they’re issued and continue until the policy expires or you cancel it. You can usually renew your policy automatically if it’s still in good standing. Policies typically have an annual premium fee, which you will pay every year regardless of whether or not you use the policy.

Costs of Cataract Surgery with a Medicare Advantage Plan

Cataract surgery is a common procedure that can improve the vision of people who have difficulty seeing clearly. However, because cataract surgery is typically more expensive than other vision treatments, many people choose to have it done through a Medicare Advantage plan.

The cost of cataract surgery will depend on the type of Medicare Advantage plan you have and whether or not you have any prior health conditions that may affect your healthcare eligibility.

It’s important to keep in mind that the costs quoted here are just examples – your actual costs may be different depending on your specific circumstances. But even if the cost of cataract surgery is higher than what’s listed here, it’s still likely covered by your Medicare Advantage plan.

What Does Cataract Surgery Cost Without Insurance?

The cost of cataract surgery without any insurance coverage was between $3,500 and $6,000 per eye. However, with Medicare insurance, the average Medicare-approved amount based on Medicare’s online tool puts the average costs at an Ambulatory surgical center at $1,600 per eye.

Cataract surgery costs will vary depending on your geographical location, medical issues you have that can impact the surgery, and which upgrades to the procedure you choose.

What Parts of Medicare Cover Cataract Surgery?

Original Medicare includes both Medicare Parts A and B. Each part of Medicare covers different aspects of your health care coverage. For instance, Medicare Part A provides coverage when admitted to a hospital, and Medicare Part B covers your doctor’s visits and outpatient medical procedures.

Cataract surgery is usually done as an outpatient procedure (Medicare Part B), but Medicare Part A covers rare circumstances where it requires hospitalization.

Medicare Eligibility

What are the Eligibility Requirements for Medicare Coverage of Cataract Surgery?

How do I get Medicare coverage for cataract surgery?

If you’re 65 or older, have Medicare Part A and B, and meet certain eye doctor standards, you’re covered.

These Medicare standards include:

  1. Cataract surgery must be deemed medically necessary by an eye doctor (ophthalmologist or optometrist).
  2. The cataract must be advanced and significantly impacting your vision.
  3. You must try, but fail, to improve your vision through the use of corrective lenses or other conservative measures.

If you have Medicare and meet the standards for coverage, you’ll pay 20% of the Medicare-approved amount for cataract surgery and the Part B deductible will apply. You can also get help with these costs through a Medicare Supplement insurance plan.

Will a Medigap Policy Cover Cataract Surgery?

A Medigap policy is a type of insurance that covers medical expenses approved by Original Medicare. Cataract surgery may be covered under a Medigap policy, depending on the specific coverage details.

Once a procedure is deemed medically necessary by your treating physician and the Medigap plan you selected covers the costs based on your Medicare Supplement plan. For example, if you have the Medigap plan F, 100 percent of all costs associated with the cataract surgery are covered. 

However, if you bought Medigap Plan K only 50% of the coinsurance cost would be covered for this same procedure.

Does Medicare Advantage Cover Cataract Surgery?

Medicare Advantage plans are a type of health insurance offered by the government. They offer benefits that are different from those offered by Original Medicare

When reviewing your Medicare Advantage plan it will be vital to review your costs associated with outpatient surgeries and your max out-of-pocket limit. Some Medicare Advantage plans offer better coverage than others, which is why it is critical to review your individual plan.

What Does Medicare Pay for After Cataract Surgery?

After cataract surgery, Medicare may cover some of the costs depending on your income and other factors.

Medicare does not cover glasses or contact lenses.

However, if you have cataract surgery that involves implanting an intraocular lens, Medicare Part B (Medical Insurance) may help pay for corrective lenses. One pair of eyeglasses with standard frames or one set of contact lenses is the minimum needed for correct vision correction.

Appeal a Medicare Denial

How can I Appeal a Decision by Medicare about Cataract Surgery Coverage Denials?

If you believe that Medicare made a mistake in its coverage determination for your particular case, you can appeal the decision. This means that someone from Medicare will look at the evidence and decide if there was a mistake made.

Appealing a decision by Medicare may result in coverage being granted for your surgery. It may also result in the coverage being changed so that it is more favorable to you.

Your doctor’s office would primarily be responsible for appealing a denial. Typically a denial happens on Original Medicare due to a mistake made by the doctor’s office not coding something correctly.

If you have a Medicare Advantage plan, denials are more common and the denial is from the insurance company. It is critical to fighting every denial of coverage no matter how you are covered by Medicare.

Does Medicare Cover Laser Cataract Surgery?

Yes, Medicare cataract surgery includes health insurance coverage for laser cataract surgery.

Medicare covers a variety of medical expenses, including laser cataract surgery. 

It is important to check with your provider before making any decisions about whether or not to have this type of surgery, as some plans may have restrictions on which procedures are covered and how much they will cover.

Frequent Asked Questions Related to Cataract Surgeries:

What is Cataract Surgery?

Cataract surgery is a procedure that removes cataracts from the eyes. Cataracts are cloudy areas in the lens of the eye, and they can cause vision problems.

It is usually performed by an ophthalmologist.

What are the Symptoms of Cataracts?

The symptoms of cataracts vary depending on the type of cataract:

  • Symptoms of nuclear cataracts include difficulty seeing in bright light and during daytime activities, blurred vision, double vision, and trouble reading newspapers or books.
  • Symptoms of secondary (transitional) cataracts may include decreased night vision, glare during outdoor activities, and sensitivity to bright lights.
  • The most common type of cataract is age-related macular degeneration (AMD), which causes gradual loss of central vision as you age.

How is Cataract Surgery Performed?

During cataract surgery, the doctor removes the cloudy lens using a special tool called an iris trephine. The doctor then replaces the cloudy lens with an artificial lens implant. This allows patients to see better without glasses or contact lenses.

There are two types of cataract surgery: open-eye and closed-eye. Open-eye cataract surgery involves removing the entire lens while closed-eye cataract surgery only removes the clouded part of the lens.

Cataract surgery is usually successful and does not require any long-term follow-up care. However, if you experience any problems with your vision after your cataract has been treated, you should consult with your doctor immediately.

What are the Risks of Cataract Surgery?

Cataract surgery is one of the most common surgeries performed in the United States. Each year, millions of people undergo cataract surgery to restore their vision.

However, there are risks associated with this procedure.

Some of the most common complications include infection, swelling of the cornea, and increased pressure.

Cataract surgery is a major operation and can be risky if not done correctly. If you’re considering cataract surgery, it’s important to know all the risks involved so you can make an informed decision about whether or not it’s right for you.

What is the Recovery Time for Cataract Surgery?

Cataract surgery is one of the most common surgeries that people undergo. It is usually safe and effective, but there is always a risk of complications. The recovery time for cataract surgery will depend on a variety of factors, including the type of surgery performed and the individual’s medical history. On average the recovery time is between 4 to 6 weeks. In general, most people experience short-term pain and discomfort following cataract surgery, but they will eventually recover and be able to resume their normal lives. If you are concerned about your cataract surgery and how long your recovery is taking always contact your doctor for re-examination.

What are the out-of-pocket costs for cataract surgery with Medicare?

How much does cataract surgery cost based on your individual Medicare plan and where surgery is done? For those covered by Medicare Part B without a Medigap policy, Medicare will cover 80 percent of the cost and the Medicare Beneficiary will cover the remaining 20 percent.

Medicare covers most of the cost of cataract surgery, and patients only have to pay a small copayment, coinsurance, or deductible. This means that the majority of the cost is covered by Medicare.

Purchasing a Medicare Supplemental Insurance Plan G can eliminate all out-of-pocket costs minus your annual deductible for Medicare Part B if it has not already been paid for the year. All Medicare Part B coinsurance and copays would be covered by the Medigap Plan G.

Many Medicare Advantage plans include cost sharing to pay for the surgery. Cataract surgery can cost a few hundred dollars to thousands of dollars with your Medicare Advantage plan.

It is vital to compare your Medigap or Medicare Advantage plan to identify all costs of the surgery.

Are there any other Financial Assistance options for Cataract Surgery?

There are a few other financial assistance options for cataract surgery, such as Medicare. Some people may be eligible for Medicaid or the Affordable Care Act’s (ACA) premium tax credits.

If you are still working and are enrolled in both an employer plan and Medicare, these two plans should supplement each other.

Do You Need Part D Coverage For Cataract Surgery?

Medicare Part D provides prescription drug coverage. As Original Medicare doesn’t provide coverage for pharmacy drugs it is important to have a Part D plan. After your cataract surgery if it’s needed your doctor may prescribe eye drops needed after your laser surgery.

What’s the Best Medicare Supplement plan for Cataract Surgery?

Medicare Supplement Plan F offers the most comprehensive health insurance benefits to cover your cataract surgery. With the Medigap Plan F, you are covered for 100 percent of the costs. The Plan F is no longer available to new Medicare Beneficiaries after January 1, 2020. Any new Medicare Beneficiaries would need to sign up for a Medigap Plan G is the next best Medigap plan.

How to Apply for Medicare Plans That Cover Cataract Surgery

Integrity Now Insurance Brokers is an experienced Medicare insurance agency. Their insurance agents are here to help you identify which plans covered by Medicare will pay the most for your medical conditions.

No matter your medical needs our licensed insurance agents will help identify the type of Medicare plan you need. Once you are fully enrolled in Medicare reach out to one of our Medicare specialists to discuss all available options.

We look forward to serving you and your Medicare needs.