Cataract Surgery and Medicare Coverage

July 9, 2019 — by Dr. Gregory Stainer
Tags: Cataract Surgery

Illustration of the cataract surgery procedureThe lens is a clear capsule within the eye that works with the cornea to reflect light so that a person can see clearly. One of the most common eye diseases to impact the lens of the eye is cataracts. Cataracts are caused by a buildup of proteins that create a cloudy film on the lens. As cataracts worsen, they significantly compromise vision, and can eventually lead to total vision loss.

Cataract surgery removes a lens that has been affected by a cataract and replaces it with an artificial lens, or IOL. Cataract surgery is the only effective treatment for cataracts, but it can be costly. Since many of our cataract patients at Southwest Eye Care and Laser are covered by Medicare insurance, they want to know how that coverage applies to cataract treatment.

Here, we answer our Bakersfield, CA patient’s most commonly asked questions regarding cataract surgery and Medicare.

Will Medicare Pay for Cataract Surgery?

Medicare generally does not cover vision services, so many patients with Medicare coverage assume that they will have to cover the cost of cataract surgery on their own. However, cataract surgery is one of the few vision procedures that Medicare does cover.

As long as a doctor provides evidence that cataract surgery is medically necessary, Medicare benefits should apply to the cost of cataract surgery, including removal of the affected lens, and the cost and placement of a basic IOL.

What about Follow-up Care?

Medicare coverage applies to all medically necessary services that are related to cataract surgery. This includes preparatory examinations, the procedure itself, and follow-up appointments. Medicare should also cover the cost of a single pair of glasses or contact lenses since many patients need to rely on prescription lenses after cataract surgery.

How Much Coverage Will I Get?

The exact coverage that a patient receives for cataract surgery will depend on the Medicare plan. Benefits for cataract surgery should be the same as those offered for other medical procedures. For instance, if patients regularly pay a co-pay, they can expect that to apply to cataract surgery as well. If patients have a supplemental insurance plan, they may get coverage for the entire procedure. Our Bakersfield team is happy to work with patients to determine their exact Medicare coverage.

Will I Have Out-of-pocket Expenses?

Most Medicare patients do have some out-of-pocket expenses for cataract surgery, but it all depends on what Medicare plan the patient has and the specifics of the procedure. While the basic cataract surgery procedure does qualify for Medicare coverage, the cost of any upgraded products or techniques will probably need to be covered by the patient.

Many of our Bakersfield patients choose to pay out-of-pocket to have premium IOLs placed, rather than basic IOLs. Premium IOLs work more like the natural lens of the eye to improve vision at various distances. This may save patients the need for prescription lenses after cataract surgery.

Contact Us

If you suffer from cataracts and would like to learn more about cataract surgery, we invite you to speak to our experienced team of eye doctors at Southwest Eye Care and Laser. Contact us at your earliest convenience to discuss your vision needs or call (661) 393-2331 or (661) 833-4040 to schedule an appointment.

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