Does Medicare Pay for Cataract Surgery?
Written by Dr. James Lehmann on 02/25/19
By the time they reach the age of 60, more than 50% of people have dealt with at least one cataract. While some of these can be handled non-invasively, some people need cataract surgery to get by. If you’re not aware of the cost, your budget is subject to a big hit from the cost of cataract surgery.
Here is everything to know about dealing with cataract surgery when you’ve got Medicare.
What Happens In Cataract Surgery
If you’re averse to surgery, it’s hard to admit that you need to have it done. If you don’t know what happens in cataract surgery, learning about it can prepare you, even if you’re squeamish.
During your surgery, your doctor removes cataracts from the lens of your eye. You then get a new artificial lens to take the place of that old cloudy lens.
The operation takes an hour. Over the course of that hour, some doctors ask patients to stay awake for the procedure. However, some people choose to take general anesthesia if they’re uncomfortable or can’t hold their eye open that long on their own.
Once you’re finished you’re often free to, however, with an eye patch attached. You’ll need to have someone get you home or to hire a car from your doctor’s office to get home. Once your eye heals, go to your optometrist to see if you need a new prescription, now that your vision has cleared p.
The Risks of Cataract Surgery
While this is a powerful and life-changing surgery for most people, it’s not without its problems. Every surgery has risks and this one is no exception.
With this surgery, there are some risks that include double vision, loss of vision, inflammation, or even infection. Keeping the area clean and clear is the key to healing correctly.
While these are real worries, it’s actually one of the safest and most common ways to deal with cataracts. More than 90% of the people who get this procedure report improved vision and no problems at all.
If you’re worried about the risks, talk to your doctor about what you can do to prepare yourself. If you have a strong rapport with your doctor, they’ll give you a real assessment of just how risky this surgery is for someone like you.
Medicare Coverage From the Start
You’ll find that you can get Medicare to cover your surgery in some respects but not in others. For example, they’ll cover the surgery to implant an intraocular lens. They’ll even cover the doctor’s services during and after your surgery.
You may need corrective lenses following the surgery, which is typically covered by Medicare.
If you sign up for outpatient treatment, you’re covered by Medicare Part B. While there may be some deductibles or copays to manage, it should be within your budget.
If you’re in the hospital for surgery, admitted as an inpatient, you’ll be under Medicare Part A. The coverage you get and the costs you pay will be much different. Since those costs are going to vary depending on the service you get, clear things up beforehand.
Your doctor and the hospital should give you an estimate before you start the process. If not, get on the phone and ensure you have an understanding before you commit to anything.
How Medicare Covers You Later
Following your surgery, you’ll be covered by Medicare Part B for a few things. The aforementioned corrective lenses should be covered once you’ve gotten new intraocular lenses applied. Medicare might pay for a single pair of glasses or contacts through a Medicare-enrolled supplier.
If you usually pay a coinsurance on something like this, expect that standard 20% to come out of your pocket. Your Part B deductible applies in this case.
While Medicare avoids coverage of most vision services, don’t rely on them for frame upgrades or additional care. Once your cataract surgery is complete, they could leave you high and dry. Call ahead to clear everything up before you commit to a stressful surgery and recovery.
Thankfully there’s potential to get some Medicare supplements to manage the cost of your cataract surgery. Medicare Supplement plans cover some of the out of pocket costs for people who struggle to pay their bills.
Those out of pocket costs like deductibles, coinsurance, and copayments add up for people on a tight budget.
Getting a Medicare Supplement or Medigap plan ensure you can cover these extended costs. Some plans help fund the charges that come up with Part B.
Since you have to pay for so many of the differences between what your doctor charges and what Medicare approves, these are a bit help. Shop around for the supplement that covers all the costs you need to worry about.
On top of Part A and Part B, there’s actually a Part C to Medicare. If you’re able to get covered under the Medicare Advantage plan, you’ll have a lot of out-of-pocket costs covered.
You’ll get all the coverage of Part A and Part B while getting some extra benefits. You’ll have lower copayments and lower deductibles. You may even have some services not covered in A or B covered in C.
Medicare Advantage extends coverage to offer plans for vision and basic dental services. This ensures you get a 360-degree plan that covers all of your basic needs at a minimum level.
The Cost of Cataract Surgery Can Be Rough
While the cost of cataract surgery may be covered by Medicare, it’s all of the additional treatment that can bury you. If you’re not prepared, you’ll pay hundreds just to get the lenses you need to see after your surgery.
Follow our guide step by step to take care of yourself following your cataract surgery.