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Does Medicare Pay for Cataract Surgery?

Along with getting older comes the potential of getting cataracts – cloudy spots in the eye lens that can have a substantial affect on your vision which includes sensitivity to glare and / or difficulty seeing at night. Fifty percent of seniors over 80 years of age will have cataracts, making cataract surgery one of the most commonly performed surgical procedures and one of the most expensive single procedures for the Medicare program.  The cost for Medicare-reimbursed cataract surgeries is approximately $3200 per eye.

The good news is that Medicare Part B covers cataract surgery as long as it is medically necessary and when it is performed by either a physician or an ophthalmologist.

Part B of Medicare also covers supplies that are needed either during or following your cataract surgery, including intraocular lens implants, as well as one pair of eyeglasses with standard frames, or one set of contact lenses – provided that they are purchased from a supplier that is Medicare approved.

In addition, an examination prior to cataract surgery will also be covered by Medicare, as well as the anesthesia that is used during your cataract surgery. And, if you opt to receive cataract surgery, however you do not receive lens implants, Medicare may also consider covering certain types of bifocals or other needed supplies.

For both the surgery itself and for the eyeglasses, you will be required to pay 20% of the Medicare-approved amount. This is on top of the Medicare Part B yearly deductible of $147 (in 2015). The deductible must be paid before Medicare will cover anything on the eligible supplies or services.

Should you opt to purchase a pair of glasses that is not fully covered by Medicare, or should you choose to obtain a certain type of enhanced intraocular lens rather than the standard one that is normally covered by Medicare Part B, then you will be responsible for paying the amount of the difference. This amount will be in addition to your 20% Medicare Part B co-insurance. It is important to keep in mind that when choosing the supplies that are needed, that you do so through health care providers who accept Medicare. Otherwise, these items may not be covered at all.

Inpatient versus Outpatient Surgery Can Make a Big Difference is Cost

It is important to understand whether you are having your cataract surgery as an inpatient or an outpatient – as this could make a substantial difference in your Medicare-reimbursable costs.

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