Does Medicare Cover Cataract Surgery?

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Asking whether Medicare covers cataract surgery is a smart move for aging individuals. Cataracts cloud the lens of your eye, adversely affecting vision quality. As people age, their risk of developing cataracts increases. And unfortunately, cataracts are the leading cause of blindness worldwide. These facts may make answering the question “Does Medicare cover cataract surgery?” vital for your health.

Cataract Surgery and Medicare Coverage

Does Medicare cover cataract surgery? The short answer is yes. Cataract surgery is covered by Medicare, as long as your doctor decides it’s a necessary surgery for your health. Here are some basic factors regarding your Medicare coverage that you should keep in mind prior to your surgery:

  • Medicare Part A is your hospital insurance. If your cataract surgery will require a hospital stay, you will need to pay your deductible under Part A. Most of the time, though, cataract surgery doesn’t require hospitalization.
  • Medicare Part B is your medical insurance, which covers medically necessary healthcare services. For cataract surgery, these benefits include your presurgery appointments and outpatient services postsurgery. You will pay your Part B deductible for these services.
  • Once you pay your deductible, you’ll receive coverage from Medicare but will still need to pay any copayments.
  • If you have Medicare Advantage, you’ll get all the benefits parts A and B provide*. Check with your particular plan to find out whether you’ll receive any extra coverage.
  • Check any Medicare Supplement Plans you have. These plans may cover some of the cost of your cataract surgery or lower your copayments.

If you need presbyopia-correcting intraocular lenses (P-C IOLs) or astigmatism-correcting IOLs (A-C IOLs), the surgery to insert the IOL is covered. However, if you need services or adjustments to the IOL that relate specifically to correction of astigmatism or presbyopia, those will not be covered by Original Medicare. Your healthcare provider should tell you this and answer any questions you have.

Estimating Your Costs

How much does Medicare cover for cataract surgery, and how much will you be responsible for paying?  Prior to surgery, it’s hard to nail down exactly what your cost will be. The services you need can vary during and after the procedure. But you can get an idea of your estimated cost by following these steps.

  1. Find out whether you’ll be inpatient or outpatient for the surgery. This impacts how you will pay.
  2. Verify that the doctor you’ll use accepts Medicare assignment.
  3. Ask your healthcare provider what you should expect to pay for the surgery.
  4. Find out which prescriptions you may need afterward. If you have Medicare Part D, check your formulary for the cost of these drugs.
  5. Verify coverage with any of your insurance providers other than Medicare and Medigap. For example, you might have benefits with Medicaid or a spouse’s employer.
  6. Check your deductibles or out-of-pocket limits. You’ll need to meet the deductible before your coverage begins. If you have an out-of-pocket limit, you won’t need to pay anything past that amount.

What About Eyeglasses or Contacts?

So, Medicare does cover cataract surgery. What about your vision needs postsurgery? Most of the time, Medicare won’t cover the cost of glasses or contact lenses. But that’s different if you have cataract surgery that implants an IOL. In that case, you have an opportunity for Medicare Part B to help cover one pair of eyeglasses or one set of contacts.

Payment details:

  • You must use a provider that’s enrolled in Medicare.
  • You must meet the Part B deductible before Medicare kicks in.
  • You’re responsible for any charges from upgrading frames.
  • Your payment will be 20% of the Medicare-approved amount.
  • Medicare covers one pair of glasses or set of lenses per cataract surgery.

Navigating the complexities of Medicare can be a challenge, and with upcoming cataract surgery, you have plenty on your plate. HealthMarkets can help. Just listen to what Nick from Intervale, New Hampshire, has to say: “I needed clear, unbiased advice, and I got it from HealthMarkets.” Whenever you have questions about your coverage, like Medicare’s coverage of cataract surgery, our licensed insurance agents are here for you. We understand your unique insurance needs, and our agents’ services come at no cost to you. If you have questions about Medicare, call us today at (800) 488-7621, or find a friendly agent near you.


References

* Hospice care is not covered under Medicare Advantage, but Original Medicare covers it for people with Medicare Advantage plans.

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https://medlineplus.gov/magazine/issues/summer08/articles/summer08pg14-15.html?mboxSession=1414072163068-28797 | https://www.medicare.gov/coverage/cataract-surgery.htmlhttp://www.aao.org/eye-health/diseases/what-is-cataract-surgery | https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html | https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html | https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/VisionServices_FactSheet_ICN907165.pdf | https://nei.nih.gov/health/cataract/cataract_facts | https://www.medicare.gov/what-medicare-covers/medicare-health-plans/medicare-advantage-plans-cover-all-medicare-services.html