There are currently more than 24.4 million cases of cataracts in the United States. As you age, your risk of developing cataracts increases. Approximately half of all Americans will develop cataracts by age 75. Before health coverage, cataract surgery can cost $3,600 to $6,000 per eye. Fortunately, Medicare can help cover these costs.
How Much Does Medicare Pay for Cataract Surgery?
Original Medicare (Part A and Part B) generally does not include vision coverage. However, cataract surgery is an exception. Part B covers basic lens implants and cataract removal. If your provider recommends an advanced lens implant, you may need to pay some or all of the additional costs. It’s essential to talk with your doctor to get a clear understanding of the necessary procedure.
After your surgery, Medicare will cover 80% of the costs for prescription glasses or contacts, but you must purchase them through a provider who accepts Medicare assignment. You will be responsible for the remaining 20%. Some beneficiaries have trouble getting Medicare to cover the glasses or contacts. If you are denied coverage, you can appeal the decision and request that they are covered. If you already paid for them out of your own pocket, you can request reimbursement. You and your health provider can write a letter to add to your appeal, just be sure to state that you had met the requirements for cataract surgery, so your glasses or contacts must be covered.
What is the Average Cost of Cataract Surgery?
Cataract surgery can range from $3,600 to 6,000 per eye before health insurance. For standard cataract surgery, the average cost is $3,600. However, the average cost of astigmatism-correcting surgery is $5,000, and presbyopia-correcting is about $6,000. If you are only enrolled in Original Medicare, you will need to pay a 20% coinsurance and your Part B deductible, which is $185 in 2019. You may be able to get even more coverage through a Medicare Supplement or Medicare Advantage plan.
Is Cataract Laser Surgery Covered by Medicare?
Medicare will cover your surgery regardless if the procedure is done conventionally or bladeless with a computer-controlled laser. Medicare will cover 80% of the cataract removal and basic lens. Similar to conventional surgery, laser surgery requires you to pay the additional costs if you require an advanced lens.
Medicare Requirements for Cataract Surgery
Your vision must be 20/40 or worse to qualify for surgery. Your doctor will need to document that your vision is at this level or lower. You also need to have difficulty completing daily living activities like reading, sewing, watching television, or driving.
It’s important to remember that the cloudiness in your eye is not directly correlated to the severeness of your cataracts. If you are unsure of your vision level or whether or not you qualify, visit your eye doctor.
Cataract Surgery and Medicare Supplements
Medicare Supplements work alongside Original Medicare and are a great way to add financial benefits to your current coverage. They can help cover your 20% coinsurance and your Part B deductible. Plan F is currently the only plan that covers your Part B deductible. However, it is going away in 2020. Beneficiaries who enroll before 2020 will be locked into this plan and can maintain coverage. If you are interested in enrolling in Plan F, fill out this form or give us a call at 833-438-3676.
Cataract Surgery and Medicare Advantage
Medicare Advantage plans are required to cover, at a minimum, the same as Original Medicare. However, MA plans offer several additional benefits like prescription drug coverage, hearing and dental coverage, group fitness classes like SilverSneakers, and additional vision coverage. Benefits will vary by plan but can include routine eye exams, eyeglasses, contacts, frames, and fittings. These benefits allow you to check your vision each year and update your prescription, lens, and frames as needed. If you are only enrolled in Original Medicare, you will need to pay for these expenses out of your own pocket.
Are you interested in learning about available plans in your area? Fill out this form or give us a call at 833-438-3676 to schedule a no-cost, no obligation appointment with a licensed agent.