What Does Medicare Cover In Cataract Surgery?

6 min read

Cataract surgery cost can be a cause of concern for many people. If you have health insurance, you are in luck. Most health insurances, including Medicare, will cover the cost of basic cataract surgery. Medicare will cover the surgeon's fees, the cost of a basic intraocular lens, and the fees for the place in which you have the cataract surgery. This will usually also include the fees for the anesthesiologist. This is the second doctor that is involved in your care during cataract surgery after the cataract surgeon. The amount of coverage for the surgeon's fees, the lens, and the surgery center will depend on your specific Medicare coverage and if you have secondary health insurance or not.

There are also certain upgrades that are available that Medicare may not cover but many people do choose to get these upgrades. More about these upgrades and their benefits are discussed below.

The most common cause of cataracts is the aging of your body's natural lens. Because cataracts are a part of the normal aging process, the majority of people who get cataracts are older. Therefore, many of these patients will be eligible for Medicare coverage. If you happen to get a cataract when you are younger, it is important that you have commercial insurance.

Cost For Cataract Surgery

If you are uninsured and develop a cataract, the cost for cataract surgery can be almost $5,000 per eye if not more. The cost for cataract surgery includes many different things.

The first part of the cost for cataract surgery is the cost of the two doctors involved in your care. The first doctor is your ophthalmologist who is your cataract surgeon. The surgeon's fee will include not only the surgery itself but also the testing that is required before surgery. There is important pre-operative testing before cataract surgery that helps the ophthalmologist figure out which lens needs to be implanted into the eye. Additionally, after surgery, a patient will have several post-operative visits. The cost for cataract surgery includes the visits before the surgery, the surgery itself, and the post-operative visits with the eye doctor. Another cost related to cataract surgery is the anesthesia that is required. Every patient will need some level of anesthesia in order to be comfortable during cataract surgery. An anesthesiologist is a doctor that will give you medicine to make you comfortable during the surgery. The anesthesiologist will also monitor your vital signs like heart rate and breathing to make sure you are stable during the procedure.

The second major cost is related to where the surgery is done, and the type of staffing and equipment that will be involved. This is likely to be more expensive than the cost of the doctors. If you are generally a healthy person with minimal medical problems, is is likely that you can have cataract surgery done as an outpatient. This means that you do not require admission to a hospital for your surgery. Outpatient surgery centers are the most common place where people have cataract surgery done. If someone has many medical problems they may need to have inpatient surgery. This means they will be an inpatient at a hospital and will likely need to stay at the hospital the night before and maybe even the night after the surgery. As expected, inpatient cataract surgery is far more expensive than outpatient cataract surgery.

Finally, the last major cost in cataract surgery is the cost of the lens. Because the natural lens of the eye is being removed from the eye, an intraocular lens must be placed into the eye. This lens is made in several different powers so that it can be closely matched to what your eye needs. There are many different types of lenses. The ones that are generally covered by insurance tend to be less expensive than specialty lenses like toric lenses or multifocal lenses.

Cataract Surgery With Toric Lens

A toric lens is a special intraocular lens that corrects a patient's astigmatism. It is typically not covered by Medicare or by any medical insurance. A patient that wants a toric lens will have to pay an additional $1500-$2000 for this lens to be placed in the eye. In addition to the cost of the lens itself, a toric lens requires the surgeon to rotate the lens to a specific axis. This means extra time and work for the surgeon. The cost of this is built into the upgrade. Toric lenses can be very valuable to people with high degrees of astigmatism. For these patients, upgrading to a toric lens could mean not having to wear glasses for distance vision. It is important to talk to your doctor about whether cataract surgery with a toric lens is right for you.

Multifocal IOL

A multifocal IOL is another specialty lens that is typically not paid for by Medicare or any other health insurance. This lens is special because it has multiple distances at which it can correct vision. That is why it is called a "multi" "focal" lens. Most lenses that are covered by Medicare are those lenses that can only focus light at distance. This means they are single vision lenses. They provide clear vision at distance only. Many patients choose to pay for an upgrade to a multifocal IOL (intraocular lens) because it means they do not have to wear reading glasses. This means they are essentially free from wearing glasses. The cost of a multifocal IOL upgrade can be anywhere from $2500 to $5000 per eye.

Laser For Cataract Surgery

Cataract surgery can be assisted with laser. Cataract surgery can not be done entirely with a laser. If your doctor is able to use a laser for cataract surgery, there are some added benefits of increased precision and accuracy. The surgical time and healing time may also be shorter when a laser is used in certain steps of cataract surgery. Remember that laser-assisted cataract surgery is not done in all patients, and the majority of patients have very good outcomes in cataract surgery. If it is available to you, it is something to discuss. with your doctor. For some patients who may be more high risk or have a history of previously complicated eye surgery, laser-assisted cataract surgery may be something to consider seriously.

What Does Medicare Cover In Cataract Surgery: Take Home Points

Medicare will cover the basic costs of cataract surgery and a single vision intraocular lens. If a patient wants a multifocal lens, a toric lens, or cataract surgery that is assisted by laser, they will have to pay additional fees. The cost of these fees will vary depending on the doctor and the type of upgrade the patient wants.

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