Cataracts are still the leading cause of blindness in the world. Cataracts are also the leading cause of PREVENTABLE blindness in the world. Thus cataract surgery is the most commonly performed surgery in every country. A common question is, “Does Medicare cover cataract surgery?” Fortunately, Medicare does cover Cataract surgery costs.
Many who have medical insurance make the mistake of believing this important procedure is not covered because they know they do not have “vision insurance.”
Most major medical plans do cover cataract surgery costs when the cataract is “medically necessary.”
What is the difference between Vision Insurance vs. Medical Insurance
Vision insurance covers routine eye exams, glasses, and contact lenses. It does not generally cover medical eye problems. Regular medical insurance covers your regular medical care, including medical problems with your eyes like the cataract surgery costs.
When is Cataract Surgery Medically Necessary?
Most insurance companies consider your cataract ripe, or medically necessary, if your vision is 20/50 or worse with glasses AND your vision bothers you in real life situations (trouble seeing signs or reading, etc.). If your visual problems reach this stage, they are considered medically necessary and the cataract surgery costs are covered according to the details of the insurance plan.
What are Symptoms of a Cataract?
Cataracts cause glare. Another way your cataract can be considered medically necessary is if you bothered by glare. Your eye doctor will do a test to measure the effect of glare on your vision. It is call a “BAT” test where a bright light is shined at your eyes while you try to read the eye chart. This is intended to duplicate the effect of a headlight shining into your eyes at night.
If your vision is 20/50 or worse during the BAT test AND you also notice glare bothering you in your real life, then most insurance companies will consider your cataracts as medically necessary and cover the costs of cataract surgery.
The amount your insurance company will pay depends on the company. Medicare, for example, pays 80% of the cost of cataract surgery after you have met your deductible.
If you have a Medicare supplemental plan, then they generally cover the other 20% of any Medicare approved cataract surgery costs after you have met the supplement’s deductible.
The Cost of Cataract Surgery: The Total Number of Cataract Surgeries in the U.S.
Medicare Cataract Eye Surgery Costs
The Medicare cataract Eye Surgery costs add up to the single largest line item expenditure for Medicare. This should not be surprising if you consider that every senior citizen has the procedure twice, once for each eye. If you add up the cost of cataract surgery for everyone on Medicare, the total expenditure is enormous. The total cost of these procedures for the nation is estimated to increase dramatically over the next decade as the baby boomer generation enters Medicare and needs cataract surgery.
The basic cataract surgery costs are covered by Medicare. The additional cataract surgery costs of laser cataract surgery are not covered and would be out of pocket expenses for the upgrade to decrease your astigmatism. There are additional benefits to laser cataract surgery of increased precision and decreased swelling. You will need to find out if your surgeon recommends cataract surgery laser for your eyes.
Cost of intraocular lenses
A lens implant (intraocular lens) is provided by Medicare as part of basic eye procedures. If you prefer an advanced technology intraocular lens that provides benefits not covered by Medicare like a toric IOL or a multifocal IOL, then your insurance would generally cover the standard cataract costs and you would pay an additional amount out of pocket to cover the costs of the higher technology lens implant.
Average Cost of Cataract Surgery
The average cost of Cataract surgery in a Medicare outpatient setting is generally around $2,500.00/eye for the surgeon, the out patient facility, and the anesthesia provider. Medicare would pay 80% or $2,000.00/eye and you would pay the remaining $500.00 out of pocket. If you have a supplement and you have already met your deductible for the year, then the supplement would cover the remaining $500.00/eye. You will need to check with your eye doctor to know the exact amounts in your region.
The procedure costs more at hospitals than at privately owned surgery centers because Medicare allows hospitals to charge more for the same services.
If you select an advanced technology upgrade or refractive cataract surgery, like laser eye surgery (like LenSx), a Toric Lens, or a Multifocal Lens (MIOL), then there would be additional out of pocket expenses to pay for the upgrades. The average cost for laser eye surgery with a multifocal lens in the U.S. is $3,500.00.
Example 1 No Upgrade–Average Costs of Cataract Surgery Per Eye:
$2,500 Average Cataract Cost – $2,000 Medicare Pays = $500 Out of Pocket – $500 Supplemental Insurance (if you have it) = $0 out of pocket
Example 2 Laser/Multifocal or Accommodating lens Upgrade Costs Per Eye
$2,500 Average Cataract Cost + $3,500 Upgrade Cost – $2,000 Medicare Pays – $500 Supplemental Insurance (If you have it) = $3,500 Out of Pocket Per Eye
Our of pocket expenses for Advanced Cataract Surgery:
Our current costs are as follows as of October 2014:
Laser Cataract Surgery with LenSx: $1150
Toric Implant (to correct for astigmatims): $900
Toric with LenSx: $1950
Multifocal Implant (Tecnis or Restor or Rezoon): $2500
Accommodating Implant (Crystalens, Trulign (for reading and corrects astigmatism): $2500
Multifocal or Accommodating Implant with LENSX: $3189
ORA: Intraoperative Aberrometry: most eyeMDs charge a separate $900 for this. We include this in the cost of all our refractive cataract surgery cases and advanced implant patients. http://oraguided.com/
How much time off of Work do I need to take off after Cataract Surgery?
Time off work or away from important activities is part of the cost of cataract surgery. Fortunately, cataract surgery recovery is usually quick and most can return to work within a day or so of the procedure. If there is a large difference between your two eyes after the surgery while you are waiting for your second eye to have the procedure, it can create some imbalance. This could create issues with depth perception. If you are involved in activities like climbing ladders etc. you might have to take more time off work. EyeMds usually ask all cataract surgery patients to limit any heavy lifting (more than 15lbs or anything that makes a patient feel pressure in the eye/head), bending, straining for 5-7 days after surgery. If a large incision was needed which is rare, this may be extended to 7-14 days. Swimming after eye surgery is usually allowed 1 month after surgery. There other actions your eye doctor could take to minimize this if necessary.
If you would like to learn more about the cost of cataract removal or the procedure, please schedule a consult with me or post your questions in the comments section.