Cataracts, often an inevitable part of aging, are the clouding of the lens of your eye, which is typically clear. Don’t know what type of lens does medicare cover for cataract surgery, Cataracts cause clouded vision, which makes it difficult for aging adults to read, drive a car, or have proper visibility at night, as well as other visibility issues.
Cataracts affect more than 20 million Americans aged 40 and above, out of which 6 million people have had cataract surgery.
A standard cataract surgery costs about $3000 to $5000 per eye. However, lens implants and other laser-assisted procedures related to cataracts may cost more.
For senior adults, one crucial query is whether Medicare covers cataract surgery. Let us explore your Medicare coverage and what type of lens does medicare cover for cataract surgery.
How Does Cataract Surgery Work?
Cataract surgery aims to treat the clouding of the eye’s natural lens, which causes blurred vision. Ophthalmologists perform cataract surgery, which usually takes about an hour.
The process involves making a minor incision in the eye to remove the lens. Then, your surgeon replaces this natural lens with an artificial intraocular lens tailored to your vision needs. This intraocular lens restores clarity and proper vision.
Cataract surgeries have a high success rate as they efficiently improve your vision, restore clarity, and compensate for your natural lens. With the advent of technology in medical sciences, cataract surgeries have now become one of the safest types of eye surgeries performed.
Recovery Period of Cataract Surgery
Cataract surgery is simple, safe, and painless, but the recovery period spans from a few days to a few weeks.
Patients can notice improvement in vision within the first 48 hours, but it can take up to 4-6 weeks for complete healing with stable vision.
Your doctor may prescribe eye drops and ask you to avoid strenuous activities for a smooth recovery.
Left untreated, cataracts can interrupt your daily life, and in some cases, even lead to blindness. But the good news is that, for the most part, cataract surgery is painless, simple and safe.
Does Medicare Cover Cataract Surgery?
The need for cataract surgery has increased over the years as cataracts have become more prevalent. Due to this increased need for surgery, various healthcare insurance plans now offer coverage for cataract surgery.
Similarly, Medicare, a renowned health insurance plan in the United States, also provides coverage for manual cataract surgery.
Original Medicare covers the basic version of manual cataract surgery, which is performed by hand and requires a lens implant, which is usually not customized to your eyes.
While Medicare covers 80% of the cost of a cataract surgery, the patients have to pay the remaining 20% with supplemental insurance or as an out-of-pocket cost.
However, Medicare Advantage, a private health insurance plan, may cover the total cost of your cataract surgery. These private health insurance plans collaborate with Medicare to provide health insurance to people aged 65 and above.
With a Medicare Advantage plan, your cataract surgery can only be performed by an ophthalmologist within your plan’s network. This may cause certain restrictions and limitations. Thus, you must check with your insurance plan before opting for cataract surgery.
What Type of Lens Does Medicare Cover for Cataract Surgery?
Both Original Medicare and Medicare Advantage cover the standard mono-focal intraocular lens (IOL). This small lens implant replaces your natural lens which is clouded by cataract, ensuring your vision is restored to pre-cataract state with clarity.
However, Medicare plans do not cover premium lenses such as toric or multifocal intraocular lenses. So, if you’re opting for an advanced lens, you must cover the cost differently as an out-of-pocket expense beyond what Medicare reimburses.
Which Medicare Plans Cover Cataract Surgery?
Several Medicare health insurance plans provide coverage for cataract surgery. Here are some of the following.
- Original Medicare (Medicare Part A and B)
- Medicare Supplemental Insurance (Medigap)
- Medicare Advantage
Original Medicare (Medicare Part A and B)
Original Medicare includes Part A, which covers hospital insurance, nursing home care, hospice, home health care, and skilled nursing facilities, while Medicare Part B covers non-hospital care such as medical equipment, preventive services, etc.
Since cataract surgeries are performed as outpatient care, Medicare Part B provides coverage for this. However, if the surgery is performed at the hospital, Medicare Part A would cover it as it is considered hospital insurance.
But remember, Part A and Part B have different reimbursements. Thus, the cost of the procedure may differ between the two settings, such as hospital versus outpatient surgical scenarios.
Medicare Supplemental Insurance (Medigap)
Supplemental insurance or Medigap plans lower the out-of-pocket costs for surgical procedures. For example, Original Medicare covers 80% of the cost of cataract surgery. However, if you have supplemental insurance, it can cover the remaining 20% of your surgical expenses.
You must thoroughly review your Medicare supplemental plans to look into your premium, co-payment, coinsurance, and deductibles. This can help you determine your out-of-pocket expenses for medical surgeries.
Medicare Advantage
Medicare Advantage plan, also called Part C, is provided by a private health insurance company that collaborates with Medicare. These private plans follow Medicare rules and regulations, and work within a specific network.
These plans may be PPO-based, HMOS, or fee-for-service in nature. Some extensive plans also cover drug prescriptions referred to as Part D.
Also, Medicare Advantage plans vary from one another since they are provided by individual private insurance companies.
Medicare Advantage provides coverage for a cataract surgery which includes a basic intraocular lens. But the coverage may be subjected to deductibles and copays. Thus you must consult your healthcare provider to make a cost-efficient decision.
How Much Does Cataract Surgery Cost With Medicare?
Let us look into a comparative table showcasing the cost breakdown for cataract surgery.
| Setting | Total Cost | Facility Fee | Doctor Fee | Medicare Payment | Patient Out-of-Pocket Cost |
|---|---|---|---|---|---|
| Ambulatory Surgical Center | $1700-$1800 | $1000 | $700 | $1400 | $300 |
| Outpatient Surgery | $2700-$2800 | $2000 | $750 | $2200 | $500 |
Opting for cataract surgery at an ambulatory surgical center (non-hospital facility) can cost around $1700-$1800.
These non-hospital facilities charge about $1000 for the facilities they provide, while the doctor fee is around $700.
Medicare pays a total of $1400, which means that the patient must cover the remaining $300 for the surgical procedure.
In contrast, having outpatient cataract surgery can cost around $2700-$2800, which includes $750 as a doctor’s fee and the remaining $2000 as the facility’s fees.
Medicare pays a total of $2200, while the remaining $500 is an out-of-pocket cost covered by the patient. These estimated prices vary according to your State and the plans offered in your area.
However, all Medicare plans cover the mono-focal intraocular lens (IOL). Thus, opting for multifocal lenses or toric lenses may have additional out-of-pocket expenses as Medicare does not cover the cost difference between standard intraocular lenses and premium lenses.
How Long Does Medicare Provide Vision Coverage After Cataract Surgery?
Any complications deemed medically necessary are covered by Medicare. However, medications such as eye drops or antibiotics are covered by Medicare Part D under drug coverage. Routine eye exams and follow-ups are not covered by Medicare.
You can also use your Medicare Advantage plan with prescription drug coverage to pay for these medicines. Some Medicare Advantage plans also provide coverage for vision, dental care, hearing problems, etc.
Enrolling in one of these private health insurance plans can help cover routine eye exams.
Find an Optimal Medicare Plan for Cataract Surgery With Silveredge
Understanding Medicare’s coverage for cataract surgery is crucial to making cost-efficient decisions.
Since Medicare plans only cover mono-focal intraocular lenses, you may have trouble choosing between a standard vs. premium lens. In this scenario, you must make use of your Medicare coverage in the best way possible to lower out-of-pocket costs for the surgical procedure.
Silveredge’s licensed advisors with industry expertise can resolve your queries by helping you pick the best Medicare plan. Our personalized guidance ensures you choose the plan that best suits your healthcare needs under all circumstances and aligns with your cataract surgery, too. Take the first step towards a clear vision with Silveredge!
