Medicare and Medicaid in some states cover cataract surgery as medically necessary, with costs typically being limited once an annual deductible is met.
Bundled Medicare Advantage plans may offer prescription drug coverage before and after procedures to help lower costs.
Cost
Cost of cataract surgery varies significantly, depending on your procedure of choice and any applicable insurance coverage you may have. Both private health insurance and Medicare Part B both cover this form of medically necessary cataract surgery when necessary.
Cataract surgery costs can also vary based on your surgeon and clinic or surgical center of choice, with larger networks likely charging more due to higher Medicare reimbursement rates negotiated with Medicare.
There are two methods of cataract surgery in the U.S.: phacoemulsification and extracapsular cataract extraction (ECE). Phaco is the more popular approach, typically performed through making miniscule incisions in the eye to accommodate for phaco’s handpiece and break down and remove natural lens material in its entirety. ECE requires surgeons to use special machines called extracapsular catheter extraction (ECCE).
ECE surgery is less commonly practiced in the US but more common in less-developed regions of the world. Under this technique, a surgeon makes a wider incision to remove the cataract without making additional cuts in its entirety.
Insurance
Private health insurance plans typically deem cataract surgery medically necessary and will cover at least some of its cost, so be sure to inquire beforehand with your insurer in regards to what coverage may apply to you.
Original Medicare covers 80% of the costs associated with cataract surgery using traditional monofocal artificial lenses; patients are responsible for paying the remaining 20% out of pocket or through Medigap policies after meeting their annual Part B deductible.
Most insurance providers do not cover premium intraocular lenses (IOLs) or additional lens implantation options like toric and multifocal lenses, so you will need to factor these costs into your overall budget. Flexible spending accounts and health savings accounts can help mitigate out-of-pocket expenses by providing pre-tax dollars from paycheck contributions; additionally, your ophthalmologist may offer payment plans through their office that help manage or lower the costs of cataract surgery.
Preparation
Your doctor will numb your eye either with drops or an injection prior to surgery and perform a vision test to assess how serious a cataract affects your eyesight.
Your surgeon will create small incisions (cuts) to access and extract the lens of your eye, then implant a clear artificial lens known as an intraocular lens implant, or IOL, that will correct your vision.
Cataract surgery is generally safe. While mild discomfort can temporarily arise after surgery, any potential risks are relatively rare but may include an infection or retinal detachment.
Your insurance coverage can have a dramatic effect on the cost of cataract surgery. To find out your options and estimate payments accurately, it is a good idea to speak to an ophthalmologist that specializes in cataract surgery and Medicare plans to understand what you can expect to pay – they may even provide financial arrangements if you don’t have coverage or simply wish to reduce out-of-pocket expenses.
Recovery
Your vision may initially appear blurry after surgery, but this should quickly improve within several days. Eye drops will be provided and a shield must be worn until you can leave hospital – the entire process typically lasts 15 minutes! Once you feel ready to leave hospital you’ll be on your way.
Some Medicare plans only cover cataract surgery performed at an in-network facility, so it’s important to speak with your surgeon prior to scheduling the procedure and determine if the lens type chosen will be covered by insurance – premium lenses that correct astigmatism or presbyopia tend not to fall under this category as they’re considered elective rather than medically necessary.
If the cost of cataract surgery is becoming a significant burden, consider setting aside money in a flexible spending account (FSA). An FSA allows you to divert pre-tax income from your paycheck into an account which can then be used for eligible healthcare expenses like cataract surgery.