Without insurance, the average cost of cataract surgery is between $3,500 and $7,000 per eye in the United States.
However, Medicare and private insurance plans often cover all, or a portion of the costs.
This can reduce your out-of-pocket expenses by 80 percent or more.
The main factors that affect the price of cataract surgery include:
- The type of IOL (intraocular lens) implanted in your eye
- The technology used in the surgery
- The cataract surgeon’s pricing
- Whether it is an outpatient procedure or it requires a hospital stay
- Pre and post-operative visits, testing, and medication
- Regional pricing variance
These variables will affect the on-paper cost of your cataract surgery.
But the biggest factor in determining your out-of-pocket cost is your health insurance coverage.
Does Medicare Cover Cataract Surgery?
Yes, basic cataract surgery is covered by Medicare. Your doctor or ophthalmologist must determine that the surgery is medically necessary for your health.
Medicare typically covers 80 percent of expenses related to cataract surgery. It also covers one pair of eyeglasses or contact lenses after the eye surgery.
Medicare Part A covers hospital stays and other inpatient procedure costs. Most cataract surgeries will not require the patient to remain overnight. But if yours does, your hospital expenses should be covered by Part A.
Medicare Part B covers medically necessary health care procedures and services.
Part B will cover:
- Your presurgery appointments
- The surgical procedure
- Monofocal lenses
- Post-surgery outpatient services.
Here are some things to take into consideration regarding Medicare coverage:
- You will be required to pay your deductible and copayment
- Monofocal IOLs are covered by Medicare
- If you want premium IOLs, you will have to pay the difference these include:
- Presbyopia-correcting intraocular lenses (P-C IOLs)
- Astigmatism-correcting IOLs (A-C IOLs)
- Multifocal lens implants
These services can double or triple out-of-pocket expenses.
It is possible to purchase a “Medigap” insurance policy from a private health insurance company. These plans are meant to provide supplemental coverage for health services not covered by Medicare. They often cover premium cataract eye surgery.
Does Private Insurance Cover Cataract Surgery?
Most health insurance providers consider cataract surgery to be medically necessary. Therefore they will cover at least a portion of the costs associated.
Cigna, Aetna, United Healthcare, and other smaller insurance providers will all cover a significant part of your cataract surgery.
Speak directly with your healthcare provider to find out what is covered by your plan.
Questions To Ask Your Healthcare Provider About Cataract Surgery
Policies vary widely from one insurance provider to the next.
Here are some questions you should ask your health care representative regarding cataract surgery:
- How much is my deductible?
- How much is my co-pay?
- Does my plan pay for prescription eyeglasses after surgery?
- Are you a “preferred provider” for any eye surgeons or surgery centers?
- If my eye surgeon is not a “preferred provider” do I need to get your approval before covering the procedure?
- Do you require advanced approval from a doctor to validate the medical necessity of my surgery?
