Does Medicare cover cataract surgery?

Does Medicare Cover Cataract Surgery?

According to Healthline, “More than 50% of Americans 80 years or older have cataracts or have had cataract surgery.” With such a high percentage of aging Americans possibly needing cataract surgery at some point, that raises the important question: Does Medicare cover it?

In nearly all cases, the answer is yes. Here is what you need to know about cataract surgery and Medicare coverage.

Cataract Surgery Requires Medical Approval from Your Doctor

In order to receive coverage for this eye operation, first your doctor needs to deem cataract surgery medically necessary. It is highly probable that your doctor will do so and provide you with the required written clearance. Cataracts are a serious eye condition not to be taken lightly. In fact, the World Health Organization identifies it as the leading cause of blindness in the world.

Left untreated, cataracts are likely to cause your eyesight to deteriorate. A cataract could render you legally blind (meaning you have severe loss of visual acuity) or unable to see at all (completely blind) if not treated. Impaired vision interferes with day-to-day activities like driving and overall quality of life.

Are you experiencing worrying symptoms of cataracts, like cloudy vision, yellowed vision, light sensitivity, changes in vision, or blurred night vision with glares and halos? Talk to your doctor about cataracts and know what is and isn’t covered by your Medicare plan before surgery.

Original Medicare & Coverage for Cataract Surgery

Medicare is a health insurance program in place for Americans 65 years old and up, or for those with special qualifying circumstances or health conditions. Estimates show 10,000 people turn 65 every day, making them eligible to receive Medicare benefits. The program is federally funded, but it does not cover all health-related expenses. If you’re a beneficiary of Original Medicare (Part A and Part B), here’s what you need to know about your coverage position and out-of-pocket costs regarding cataracts.

Original Medicare covers the pre-surgery exam, cataract removal, lens implantation and one set of standard prescription contacts or prescription eyeglasses following the surgery.

This federal health insurance coverage is limited to the two most common types of surgery: phacoemulsification and extracapsular surgeries. Both surgeries are effective, and your doctor will help determine which one will suit you best.

The exact cost of cataract surgery is difficult to pin down. However, Healthline estimates that treatment in a clinic averages $195 out-of-pocket and hospital treatment may cost up to $383 out-of-pocket. Without Medicare coverage, surgery and treatment can range from $3,000 to $6,000 per eye.

What Vision Related Medical Expenses Aren’t Covered by Medicare?

In general, Original Medicare (Part A and Part B) provides partial coverage for hospitalization, inpatient care and medical out-patient care, which does not include routine vision exams and related costs. Some expenses that may not be covered include eye exams, glasses and contact lenses. The amount you pay depends on your Medicare plan coverage, medications needed, and whether you have supplemental health insurance in the form of Medigap or Medicaid. If you have eye conditions that require special care during treatment or surgery, that may affect the costs as well.

If you’re not financially eligible for Medicaid, Medicare supplemental insurance is always an option that is available to you. Keep in mind that Original Medicare typically covers 80% of your medical costs. The remaining amount paid for deductibles, coinsurance and copayments will come out of your pocket (along with the monthly deduction from Social Security payments that most enrollees pay for Medicare premiums), and they can add up quickly. Medicare supplemental insurance plans are offered by private insurance companies to address this gap and help cover medical costs as described in the plan coverage documents. Medicare supplemental insurance may also be referred to as a Medigap plan, and these plans are offered by Medicare insurance agents in your area. Talk to an experienced, local Medicare agent if you need to re-evaluate your coverage or wish to know your possible plan options.

Should you need assistance navigating your Medicare coverage or learning more about Medicare supplemental insurance, reach out to our team at Medicare Portal. Our services are 100% free, and we’re available online, over the phone and in-person to discuss your coverage concerns and costs from health issues, developing cataracts and much more.

 

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