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. If you have one of the millions of cases of cataracts, you may wonder, “Does Medicare cover cataract surgery?” Yes. Medicare can help cover these costs if you qualify.
How Much Does Medicare Pay for Cataract Surgery?
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.
Does Medicare Cover Glasses or Contacts?
For the most part, Medicare does not cover routine vision care, glasses, or contact lenses. However, Medicare can make an exception
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.
Does Medicare Pay for Laser Cataract Surgery?
Medicare coverage for cataract surgery doesn’t depend on the surgical method. Medicare will cover 80% of the cataract removal and basic lens whether the procedure is conventional or bladeless with a computer-controlled laser. Similar to conventional surgery, laser surgery requires you to pay the additional costs if you require an advanced lens.
How to Find a Cataract Surgeon Who Accepts Medicare
Ophthalmologists are eye doctors who specialize in vision correction and care. Many times your ophthalmologist will perform your cataract surgery. Medicare.gov’s physician compare tool can help you find an eye surgeon who accepts Medicare.
Click here to get started. First you’ll come to the physician finder tool. Enter your zip code in the search bar beside the red arrow. We used 37209, which is our corporate offices’ zip code in Nashville, TN.
Then type “ophthalmology” in the search bar above the green arrow. Then click “Search” beside the yellow arrow.
Then you’ll come to a list of ophthalmologists who currently accept Medicare. Use the contact info to call different doctors to find the right fit.
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.
What Are Cataracts?
Our eyes have a lens that works much like a camera. The lens bends light so you can see your surroundings. A cataract makes that clear lens cloudy, and it can be more difficult to read or drive a car.
What Causes Cataracts?
Most of the time, cataracts develop with age, or when an injury changes your eye’s lens. As you age, the lens can become stiffer, thicker, and less transparent.
Sometimes genetic disorders, other eye conditions, medical conditions such as diabetes, or past eye surgery can contribute to cataract development. Other causes can be long-term steroid medication use.
According to the Mayo Clinic, signs and symptoms of cataracts can include:
- Cloudy, blurry or dim vision
- Increasing difficulty seeing at night
- Sensitivity to light and glare
- Need for brighter light for reading and other activities
- Seeing “halos” around lights
- Frequent changes in glasses or contact lens prescription
- Fading or yellowing of colors
- Double vision in one eye
How Do You Know If You Need Cataract Surgery?
Talk to your doctor if you experience any changes to your vision such as cloudiness or halos around lights. According to Harvard University, you should have an eye exam every year if you’re 65 or older.
Dr. Laura Fine, an ophthalmologist with Massachusetts General Hospital, says you don’t need cataract surgery until you think you need to see better.
Learn More About Medicare and Cataract Surgery
A licensed agent with Medicare Plan Finder may be able to find plans in your area that fit your budget and lifestyle needs.
Are you interested in learning about available plans in your area? Fill out this form or give us a call at 844-431-1832 to schedule a no-cost, no obligation appointment with a licensed agent.