Cataracts are the leading cause of blindness in the world, and more than 50% more adults over 80 in the United States choose to have cataract surgery. Most of the people in this age group have Medicare insurance. It’s important to know what aspects of your cataract surgery your Medicare coverage encompasses. This way, you won’t get surprised with out-of-pocket expenses.
Cataracts are a medical condition where your eye’s natural lens clouds over. Once cataracts start to form, your lens will get more opaque, and light won’t be able to reach your retina. You can develop cataracts in a single eye or both eyes at the same time.
As you develop cataracts, your perception of headlights, colors, and sunlight can start to change. Some people experience double vision. This may happen if cataracts begin to cause a difference in the opacity levels across the lens. Some people experience all of these symptoms, and some people won’t experience anything but decreased vision.
To restore your vision, many people choose to have cataract surgery. This is an outpatient procedure that typically takes less than an hour from start to finish. You’ll go home with an eye patch, and eye drops to help with any pain or itching you experience. When you go back to your doctor for the follow-up, they’ll remove the eye patch. You should be able to see clearly again.
Types of Cataract Surgery Medicare Covers
There are two primary types of cataract surgery. The good news is, Medicare covers both surgeries at the same rates. The surgeries include:
- Extracapsular – This surgery works to remove the cloudy lens in one piece. Once the surgeon removes the lens, they’ll insert an intraocular lens to replace the lens they removed.
- Phacoemulsification – Your surgeon will use an ultrasound to break up the clouds lens before they remove it. Once it’s out, they’ll replace it with an intraocular lens.
The average cost for cataract surgery for one eye is approximately $3,500, but costs vary based on where you have the procedure. This cost generally covers the outpatient surgery center fee, surgeon’s fee, implant lens, anesthesiologist’s fee, and three months of postoperative care. This rate will vary depending on your state, needs, and your condition.
Medicare Coverage and Cataract Surgery Costs
Medicare will cover the bulk of your cataract surgery cost if it is deemed medically necessary and your physician accepts Medicare. Still, you will have a small percentage leftover that you’ll have to pay if you don’t have a supplementary insurance plan or are enrolled in a Medicare Advantage plan that offers additional coverage. Most people have cataract surgery in either an Ambulatory Surgical Center or Hospital Outpatient Department.
Medicare Insurance and Aftercare
Additionally, Medicare may cover some expenses as long as they’re a result of your cataract surgery. Most of the time, Medicare won’t pay for contact lenses or glasses. However, this changes if your cataract surgery involves implanting an IOL. If this is the case, you have a one-time opportunity for Medicare to cover either one set of contacts or one pair of glasses. There are a few details you have to meet before Medicare will step in, and they include:
- Your cataract surgery provider has to be participating in Medicare
- You have to meet your Medicare Part B deductible
- If you want to upgrade your glasses frames, you have to pay for the upgrade
- You’ll have to pay 20% of the Medicare-approved amount
- Medicare will only pay for one set of contact lenses or one pair of glasses per surgery