All About Medicare Cover Cataract Surgery

Jan 31, 2024 By Susan Kelly

More than half of all Americans aged 80 and up have cataracts or have had surgery to remove them[1]. Cataracts cause clouding of the eye's lens, leading to impaired vision. Cataracts can affect one or both eyes. Cataract surgery involves surgical removal of the cloudy lens and its replacement with an artificial one.

Knowing how much surgery will set you back is essential. Since cataracts are more common in the elderly, many want to use Medicare, the federal health insurance program primarily for U.S. citizens aged 65 and up, to cover the cost of the surgery. Read on to learn about cataract surgery and Medicare's coverage policies.

Cataract surgery is typically completely covered by Medicare Advantage plans. But, as Herrin points out, "many physicians, hospitals, and surgery centres are not connected with many of the Advantage plans," so it's vital to double-check that your insurance will cover the procedure before making an appointment. Meanwhile, according to Herrin, Original Medicare has agreements with virtually all medical facilities.

How Comprehensive Is Medicare Coverage For Cataract Surgery?

An artificial lens is implanted inside the eye to take the place of the natural lens once clouded by a cataract—surgical assistance from the facility and the surgeon—one set of corrective glasses or lenses.

Does Medicare Have Cataract Surgery Done cover it? Cataract surgery at an ASC costs roughly $1,789 ($750 in doctor fees and $1,039 in facility expenses), as reported on Medicare.gov. The Medicare portion, $1,431, leaves the patient responsible for the remaining $357. (Ambulatory surgical centers are out-of-hospital healthcare facilities that treat patients who do not require continuous monitoring for longer than 24 hours.)

Costs associated with having cataract surgery performed through an outpatient department of a hospital total $2,829 ($750 for professional medical fees and $2,079 for hospital charges). The Medicare portion, $2,263, leaves the patient responsible for $565. Cost estimates are in a range since they depend on factors including location and the severity of cataracts.

What Does Cataract Surgery Cost With Medicare?

Cataract surgery at an ASC costs roughly $1,789 ($750 in doctor fees and $1,039 in facility expenses), as reported on Medicare.gov. The Medicare portion, $1,431, leaves the patient responsible for the remaining $357. (Ambulatory surgical centers are out-of-hospital healthcare facilities that treat patients who do not require continuous monitoring for longer than 24 hours.

Costs associated with having cataract surgery performed through an outpatient department of a hospital total $2,829 ($750 for professional medical fees and $2,079 for hospital charges). Does Medicare cover cataract surgery? The Medicare portion, $2,263, leaves the patient responsible for $565. Cost estimates are in a range since they depend on factors including location and the severity of cataracts.

Medicare Advantage plans they offer a wide range of coverage and prices for cataract surgery. Get in touch with a provider's how much Medicare covers for cataract surgery customer care contact to ask about pricing details before you go through with the operation.

What Are Medicare Benefits Necessary for Cataract Removal?

Part B of Medicare, which covers medical treatment for people who are not hospitalized, includes cataract surgery in its list of approved procedures. Medicare Advantage plans typically cover cataract surgery; however, what type of lens does Medicare cover for cataract surgery? You will need to use a doctor and hospital that are part of your plan's network.

Part B deductibles must be met before Original Medicare will pay for cataract surgery; after that, the patient is responsible for paying the remaining 20% (either out of pocket or with supplemental insurance.

However, a copayment may be necessary for Medicare Advantage plans. Regardless, before scheduling any visits, you should acquire a thorough explanation of your coverage. Medicare's pricing lookup tool for procedures is another option for cost estimation.

Is There a Special Medicare Plan for Cataracts?

Cataract surgery is one of the few medical procedures fully covered by Medicare Advantage plans. However, you will need to choose a surgeon, clinic, or hospital that accepts your Advantage plan. Getting an Advantage plan with minimal copays and vision insurance could be another way to cut costs.

While most medical facilities accept Original Medicare patients, not all accept Medicare Advantage patients. In addition, you'll be responsible for paying 20% of the entire price of the treatment.

To supplement your original Medicare Part B coverage, you may want to look into a Medicare Supplement (Medigap) plan. For example, Plan G will pay for your cataract surgery, leaving you only responsible for your Part B deductible and Medigap premiums.

However, routine eye exams and corrective glasses are not included. After Cataract Surgery, Do Patients Have to Pay Out of Pocket for Glasses Under Medicare? After your cataract surgery, Medicare will pay for a single pair of glasses with standard frames or a single box of contacts if your doctor recommends them. A Medicare-approved vendor is required for the purchase of these corrective lenses.

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