Cataracts are common in seniors. One in five Americans by age 65 have or had a cataract, which increases to one in two by age 80. Given that statistic, you may wonder if Medicare covers cataract surgery? The short answer is yes.
Several factors determine how much cataract treatment Medicare will cover, and how much you will need to pay out-of-pocket. If you think you have cataracts, consult with your doctor regarding diagnosis and treatment options.
What Are Cataracts?
A cataract is the clouding of your eye’s natural lens. This can occur in one or both of your eyes. While the cause is unknown, the breakdown of lens proteins and changes associated with aging are contributing factors.
If you have cataracts, it may seem like you’re looking through a frosty or fogged-up window. They can also affect your perception of colors, sunlight, and headlights. Other symptoms may include double vision, blurred or dim vision, and sensitivity to light.
Non-Surgical Cataract Treatment and Medicare
Depending on the severity of your cataracts, your doctor may not recommend surgery. Non-surgical options such as new prescription glasses or contacts, anti-glare sunglasses or magnifying glasses can sometimes improve your vision enough to avoid surgery.
Original Medicare doesn’t cover this routine, non-surgical vision correction unless you need it after cataract surgery. However, some Medicare Advantage (Medicare Part C) plans include separate vision benefits.
Cataract Surgery and Medicare
Now that you know a little more about Medicare and cataracts that don’t require surgery, let’s take a look at surgical options.
Cataract surgery is a simple procedure that involves replacing the natural lens in the affected eye with an artificial one. If you have cataracts in both eyes, you’ll likely have it performed on one eye at a time.
Since cataract surgery is typically performed on an outpatient basis, it’s covered under your Medicare Part B benefits. Medicare Part B also covers:
- Eye exams to diagnose serious vision problems (even if your doctor finds nothing wrong)
- Pre-surgery eye exams
- Anesthesia during surgery
- Removal of cataracts
- Basic (monofocal) lens implants
- One pair of prescription eyeglasses or contact lenses after surgery
- Up to one year of follow-up care
How Much Does Medicare Cataract Surgery Cost With No Extra Coverage?
For example, say you need cataract surgery on one eye, and it costs $3,420 for the standard procedure. You would need to pay 20 percent after you meet your deductible. (The 2020 deductible for Medicare Part B is $198.) The table below gives a breakdown of the costs:
|Cataract Surgery||Medicare Coverage||Out-of-Pocket||Deductible||Total Cost to You|
The cost of your surgery will depend on several factors including the type of intraocular lens (IOL) you get, the technology used, and the surgeon who performs it.
If you undergo laser cataract surgery, you will likely need to pay the added costs yourself. This is also the case if you receive a premium toric IOL for astigmatism or a presbyopia-correcting IOL.
Paying for Cataract Treatment With Extra Medicare Coverage
Medigap or Medicare Advantage plans are the most common ways to extend your Medicare coverage for cataracts.
Medigap Cataract Help
Premium cataract surgery, which also corrects astigmatism or presbyopia, may double or even triple your out-of-pocket costs. If you want this type of surgery, a Medicare Supplement (Medigap) plan may help you pay for the expenses not covered by Medicare.
A Medigap plan is an add-on to Medicare from a private insurance company that helps pay your out-of-pocket care costs for services that Medicare doesn’t pay for completely. Keep in mind, all doctors who accept Medicare Part B must take these plans as well.
Medicare Advantage Cataract Help
A Medicare Advantage plan (Medicare Part C) is a private insurance plan that replaces your Medicare Part A and Part B benefits. Some Medicare Advantage plans offer additional routine vision benefits, but at the very least all of these plans must cover services that are equal to Medicare Part A and B.
Your share of the cost will depend on your plan, but your contribution never exceeds your out-of-pocket maximum ($6,700 in 2020). Refer to your annual Summary of Benefits and Coverage to see your plan’s particulars.
Eyeglasses and Contacts After Cataract Surgery
If you undergo standard cataract surgery, you may need to continue using glasses or contacts.
Medicare Part B will cover 80 percent of the cost of conventional contacts or eyeglasses after your surgery. If you pick more expensive frames, you’ll need to pay the difference. Be sure to ask your optometrist about what Medicare will cover. Your out-of-pocket cost can vary depending on the lens selected.
Before you buy, make sure your supplier has a Medicare supplier number. Medicare won’t pay your claim without one. Also, tell your optometrist to send the bill to Medicare.
Cataract Treatment Begins With a Consultation
Since costs vary significantly, you should start by booking a consultation with an ophthalmologist. He or she can give you an estimate based on your needs and treatment options.
If you have a Medicare Advantage plan, call your insurance provider to confirm how it covers the type of treatment you’re looking for and about any coverage rules, such as prior authorization or a network. If you have a Medicare Supplement plan, your coverage will pair with Medicare automatically.
Although Medicare and cataract surgery coverage may seem complicated, millions of seniors undergo successful procedures every year. The procedure itself is simple, low-risk, and can permanently improve your vision.
Cataract surgery doesn’t have to be expensive either. There are a few ways to lower your out-of-pocket costs. These include choosing standard surgery, buying a Medicare Supplement plan, or in some cases, switching to Medicare Advantage.
As you start your journey toward better vision, ask questions. Your doctor and insurance provider can help you decide which options meet your needs and budget.