How Much Of Cataract Surgery Does Medicare Cover?

Vincent Thrasher

Founder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior...Read more

Cataract surgery is a common procedure that many seniors undergo every year. However, the cost of the surgery can be a major concern for those on a fixed income. Luckily, Medicare does cover a portion of the cost, but how much exactly? In this article, we will explore the coverage options available for cataract surgery under Medicare and provide clarity on what is covered and what is not. So, if you or a loved one is considering cataract surgery, keep reading to learn more about Medicare coverage.

Understanding Medicare Coverage for Cataract Surgery

If you have cataracts, you may be wondering about the cost of surgery and whether Medicare will cover it. Cataract surgery is a common procedure that involves removing the clouded lens of the eye and replacing it with an artificial lens. In this article, we will discuss how much of cataract surgery Medicare covers, and what you can expect in terms of out-of-pocket costs.

Medicare Coverage for Cataract Surgery

If you have Original Medicare (Part A and Part B), cataract surgery is covered under Part B, which covers medically necessary outpatient procedures. Medicare will cover the cost of the surgery, including the surgeon’s fees, anesthesia, and facility fees.

However, Medicare only covers the standard monofocal lens that is typically used during cataract surgery. If you choose to get a premium lens, such as a multifocal lens or a toric lens, you will have to pay the additional cost out of pocket.

It’s important to note that Medicare only covers cataract surgery if it is deemed medically necessary. This means that your vision must be impaired to the point that it is interfering with your daily activities.

Out-of-Pocket Costs for Cataract Surgery

While Medicare covers the majority of the cost of cataract surgery, there are some out-of-pocket expenses you should be aware of.

First, you will be responsible for paying the Part B deductible, which is $203 in 2021. After you meet the deductible, you will be responsible for paying 20% of the Medicare-approved amount for the surgery.

If you choose to get a premium lens, you will also have to pay the additional cost out of pocket. Premium lenses can cost anywhere from $1,000 to $4,000 per eye, depending on the type of lens.

Benefits of Cataract Surgery

Cataract surgery can greatly improve your vision and quality of life. After the surgery, you may experience improved color vision, better night vision, and less glare and halos around lights. You may also be able to reduce your dependence on glasses or contact lenses.

Furthermore, cataract surgery has a high success rate and is generally a safe and effective procedure. Most people are able to return to their normal activities within a few days of the surgery.

Cataract Surgery vs. Alternative Treatments

If you have cataracts, you may be wondering if there are any alternative treatments available. While there are some non-surgical treatments that can help manage cataracts, such as using brighter lighting or magnifying glasses, the only way to remove cataracts is through surgery.

In some cases, cataracts may not need to be removed right away if they are not causing significant vision problems. However, if your cataracts are interfering with your daily activities, cataract surgery is the most effective treatment option.

Conclusion

In conclusion, if you have cataracts and are enrolled in Original Medicare, cataract surgery is covered under Part B. While Medicare covers the majority of the cost of the surgery, you will be responsible for paying the Part B deductible and 20% of the Medicare-approved amount for the surgery.

If you have additional questions about Medicare coverage for cataract surgery, it’s always best to consult with your doctor or a Medicare representative.

Frequently Asked Questions

Question 1: What is Cataract Surgery?

Cataract surgery is a procedure that involves removing the cloudy lens of an eye and replacing it with a clear artificial lens. The cloudy lens is usually caused by a cataract, which is a buildup of protein in the eye’s lens. Cataract surgery is typically an outpatient procedure that takes less than an hour to complete, and it is one of the most common surgeries performed in the United States.

Question 2: Does Medicare Cover Cataract Surgery?

Yes, Medicare covers cataract surgery. Medicare Part B, which is the medical insurance portion of Medicare, covers the cost of the surgery, including the surgeon’s fees, the cost of the intraocular lens, and the operating room fees. However, there may be additional costs associated with the surgery, such as the cost of prescription eye drops, so it is important to check with your doctor and your Medicare plan to understand your out-of-pocket costs.

Question 3: Are There any Restrictions on Medicare Coverage for Cataract Surgery?

There are some restrictions on Medicare coverage for cataract surgery. For example, Medicare will not cover the cost of premium intraocular lenses, which are more advanced lenses that can correct for astigmatism or presbyopia. Additionally, Medicare will only cover cataract surgery if it is medically necessary, which means that the cataract is affecting your ability to perform daily activities, such as driving or reading.

Question 4: What Happens if I Need Cataract Surgery in Both Eyes?

If you need cataract surgery in both eyes, Medicare will cover each surgery separately. However, there may be a waiting period between surgeries, depending on your individual circumstances. Your doctor can provide more information about the timing of your surgeries and what to expect.

Question 5: How Do I Find a Doctor who Accepts Medicare for Cataract Surgery?

To find a doctor who accepts Medicare for cataract surgery, you can use the physician finder tool on the Medicare website. You can search for doctors by location and specialty, and you can also check their profiles to see if they accept Medicare assignment. Additionally, you can ask your primary care physician or ophthalmologist for a referral to a surgeon who accepts Medicare.

In conclusion, Medicare coverage for cataract surgery is a significant relief for many seniors who may be suffering from this condition. Since cataract surgery is a common procedure among the elderly, it is important to know what Medicare covers and what it does not. Although Medicare covers a large portion of cataract surgery costs, there may still be some out-of-pocket expenses that patients need to pay. It is important to consult with your doctor and Medicare provider to understand the full extent of coverage and any potential costs associated with the surgery.

Overall, Medicare’s coverage of cataract surgery helps to ensure that seniors can receive the necessary treatment without the burden of high medical bills. The amount of coverage provided by Medicare can vary depending on the type of medical plan and the specific treatment needed. However, with proper planning and understanding, many seniors can receive the necessary treatment without any significant financial strain.

In summary, Medicare provides a valuable safety net for seniors who need cataract surgery. While there may be some costs involved, the coverage provided by Medicare can significantly reduce the financial burden of this important medical procedure. If you or a loved one is in need of cataract surgery, it is important to consult with your doctor and Medicare provider to understand the extent of coverage and any potential costs.

Vincent ThrasherFounder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior insurance, encompassing Medicare, Medigap, long-term care insurance, life insurance, and dental, vision, and hearing insurance. Vincent's unwavering passion for guiding seniors through the intricate insurance landscape and crafting customized solutions to address their individual needs has earned Over65InsuranceOptions an esteemed reputation as a dependable ally for seniors nationwide.

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