Cataracts are one of the leading causes of vision loss in individuals over the age of 65. Cataracts cloud the eye’s crystalline lens and obstruct a person’s central vision. In their earliest stages, cataracts can be controlled through conservative treatment methods, such as medication and prescription eyewear. However, eventually a patient will require cataract surgery to remove the affected lens.
Since cataracts primarily affect the elderly, many cataract patients rely on Medicare for their insurance coverage. Dr. Steven Chander believes it is important that our Chicago, IL, patients understand how Medicare coverage applies to cataract surgery. Dr. Chander and our team at Primary Eye Care Associates go over Medicare coverage with our patients so that they can properly plan for any out-of-pocket costs of treatment.
Is Cataract Surgery a Covered Procedure?
It is common for people to be confused about whether or not Medicare coverage will apply to cataract surgery. In general, Medicare does not provide coverage for vision care. Understandably, most people assume this means that cataract surgery is not a procedure that is covered by Medicare. However, cataract surgery is performed as a vision-saving procedure, so it is considered medically necessary in most cases.
If a doctor deems cataract surgery medically necessary, Medicare will provide coverage for the procedure. Since cataract surgery typically does not involve a hospital stay, it is covered by Medicare Part B, that which covers medically necessary healthcare services.
How Much Coverage Will I Get?
The amount of coverage that Medicare will provide for cataract surgery depends on the exact plan and coverage that a patient has. With a basic Medicare plan, also known as Original Medicare, patients can expect coverage for:
- Cataract removal (including surgeon fees)
- A basic intraocular lens replacement
- Pre- and post-surgical appointments
- One set of prescription lenses
Again, Medicare benefits vary, so specific coverage may be slightly different for each patient. Additionally, some of our Chicago patients only have Medicare coverage, while others have supplemental insurance plans. This also affects how much coverage a patient will get for the procedure. Our team can look into each patient’s specific insurance plan to determine exactly what coverage they will be provided.
Should I Expect Out-of-Pocket Costs?
Even with Medicare coverage, many patients have some out-of-pocket expenses for cataract surgery. In most cases, out-of-pocket costs are minimal. If a patient has any deductibles under Medicare Part B, these will apply to cataract surgery. Any applicable copays will also need to be covered by the patient.
In addition to the normal out-of-pocket costs of cataract surgery, some of our Chicago patients choose to pay for premium services that are not covered by Medicare insurance. Most commonly, patients elect to have premium intraocular lenses placed, rather than basic IOLs. Premium IOLs react more like the natural lens of the eye, so they can improve vision at both near and far distances. Although premium IOLs cost more than basic IOLs, many patients find that the extra cost of treatment is well-worth the convenience of being able to see clearly without prescription lenses.
If you have questions about cataract surgery or what type of coverage you will get from your Medicare plan, Dr. Steven Chander and our team at Primary Eye Care Associates would be happy to provide you with more information. Contact us at your earliest convenience or call (773) 735-6090 to schedule an appointment.