Have you noticed halos around lights when you drive at night? Do you need more light to read than before? The unfortunate news is that these are just some of the subtle symptoms of cataracts when they first begin to develop. It’s estimated that 20 million Americans over the age of 40 have cataracts, and that number is expected to keep growing. The great news is that cataract surgery can correct this all too common eye problem, and if deemed a medical necessity, Medicare will most likely cover the procedure. Determining the extent of your cataract surgery coverage with Medicare Original or Advantage can be time consuming and confusing, so we have compiled some of the most relevant information for you below!
Understanding Cataract Surgery and it’s Importance in Fixing Cataracts
Cataracts are one of the most common eye problems, causing over 51% of blindness worldwide, however, cataract surgery can provide an often permanent solution. Cataracts occur when protein deposits begin to develop in the lens of the eye. In the initial stages of cataracts, you may not even realize something is wrong with your vision as the change can be very subtle, such as needing more light to read. As time goes on and the cataracts progress, your vision may become more and more cloudy and foggy until you are unable to see.
While contact lenses and eyeglasses may help in the initial stages of cataract development, as the problem progresses, the only way to properly fix cataracts is to undergo cataract surgery. Cataract surgery involves cutting out the impacted, clouded lens and replacing it with an intraocular lens (IOLs). There are different types of IOLs to choose from that will impact your post-surgery vision, depending on the severity of your case and any other eye conditions you may have. Cataract surgery has a high success rate and is one of the most commonly performed eye surgeries in the world. It’s important to find a surgeon you trust to perform the surgery, so don’t hesitate to reach out to the OCLI Vision team to schedule a consultation.
The Different Types of Intraocular Lenses
When you go in for your cataract surgery consultation, your surgeon will explain your options for lens replacement. An IOL is the clear, artificial lens that will replace your clouded, deposit filled natural lens, allowing you to see clearly. Unlike the lens replacements of the past, there are different kinds of IOLs available, depending on the current state of your eyes and your objective for post-surgery eye sight. Luckily, a knowledgeable surgeon can help you choose between monofocal, multifocal, and toric lenses, but here’s a quick overview of the differences.
- Monofocal lenses are the most common and allow you to focus on one fixed distance; far, mid-range, or close up. You will most likely still require glasses or contacts to see well at all distances if you choose a monofocal lens. This is a great option for patients with cataracts in both eyes and is generally the most cost effective as well. These are often the standard lenses covered by Medicare.
- Multifocal lenses have different focal zones, allowing you to see close-up and far away. Over time, you should be able to rely less on your contacts or reading glasses for close-up tasks. Keep in mind that it may take awhile to adjust to multifocal lenses after cataract surgery.
- Toric lenses were created to fix astigmatism and come in monofocal, multifocal, or accommodative models. These lenses have a unique shape that allows them to correct for the curvature of the cornea that causes astigmatism. With these lenses most patients will not required glasses following cataract surgery.
Understanding Medicare Coverage for Cataract Surgery
Now for the fun stuff; Medicare coverage. First, if cataract surgery is deemed a medical necessity by your surgeon, Original Medicare (aka Medicare Part A and Part B) and Medicare Advantage will most likely cover the procedure. However, there are a few important things to know about deductibles, specialty IOLs, and the criteria required to ensure coverage.
As mentioned above, if your surgeon determines that having cataracts is interfering in your life and you have difficulty driving, working, reading, or watching TV, Medicare will cover your outpatient cataract surgery procedure under Medicare Part B which is medical insurance. After your deductible is met, you will pay 20% of the Medicare-approved amount for surgery costs for a standard IOL implant. If you elect to have a more advanced IOL placed, that will not be covered by Medicare. Additionally, You will also need to confirm if your surgery will be laser-assisted, as that may not be covered by Medicare.
The covered portion of the surgery should also include pre- and post-operative care services, including pre-surgery exam, post-surgery care, and prescriptions for one set of standard frame eyeglasses or contact lenses after cataract surgery. Whichever costs are not covered by Medicare are your responsibility, so be sure to have a clear idea of how much the procedure will cost before scheduling your surgery.
If you have Medicare Advantage or Part C, which is provided by private insurers, you will still have coverage for cataract surgery, however it may cover additional costs of the procedure or it may provide less coverage, it depends on your plan. You will need to check with your plan provider for the exact information on deductibles, copayments, and using in-network vs out-of-network providers as it will vary.
Quick Facts: Medicare Coverage for Cataract Surgery:
- Medicare will cover cataract surgery if you meet the necessary medical criteria
- Original Medicare will cover 80% of the Medicare-approved amount of the procedure
- Medicare Part B will cover one pair of eyeglasses or contact lenses post surgery
- Medicare will not cover advanced IOLs or laser-assisted surgery
Additional Cost Considerations
Even though they are not covered by Medicare, there are distinct advantages to getting advanced IOLs or undergoing laser-assisted cataract surgery. As discussed above, advanced IOLs can provide advantages to people that struggle with astigmatism and nearsightedness. These options might be especially appealing if you have developed cataracts at a younger age, wish to correct your vision only once, or you do not want to rely on glasses after your surgery.
Cataract surgery cost considerations to keep in mind:
- The Medicare Part B deductible for 2024 is $240
- The cost for advanced IOLs will depend on your location and chosen practice, but can run anywhere from $1,500 to $4,000.
- Medigap is a supplemental Medicare policy that will cover coinsurance and out-of-pocket expenses.
Cataract surgery is a life-changing procedure that should not be delayed because of concerns around costs. Medicare is a very comprehensive service and there are lots of options that can help you cover even out-of-pocket expenses. If you need more information before scheduling a cataract surgery consultation, take a look through the following resources:
- Cataract Surgery Information from OCLI
- Medicare coverage
- Medicare Advantage and Medigap Programs from AARP
- Intraocular Lens Options for Cataract Surgery from the American Academy of Ophthalmology
At OCLI Vision, we specialize in cataract surgery and would be delighted to answer all of your questions. Call today at 833-509-6254 or visit online to schedule a consultation with one of our exceptional eye care surgeons.
