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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, which can reduce your out-of-pocket expenses by 80 percent or more.
The main factors that affect the price of cataract surgery include:
While these variables will affect the on-paper cost of your cataract surgery, the biggest factor in determining your out-of-pocket cost is your health insurance coverage.
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Yes, basic cataract surgery is covered by Medicare, as long as your doctor or ophthalmologist determines that the surgery is medically necessary for your health. Medicare typically covers 80 percent of expenses related to cataract surgery, as well as one pair of eyeglasses or contact lenses after the surgery.
Medicare Part A covers hospital stays and other inpatient procedure costs. Most cataract surgeries will not require the patient to remain overnight, however, 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, and post-surgery outpatient services.
Here are some things to take into consideration regarding Medicare coverage:
Advanced cataract surgery with premium toric IOLs, premium presbyopia-correcting IOLs, or advanced technology, such as laser cataract surgery, will include additional costs that are not covered by Medicare. 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 and often cover premium cataract eye surgery.
You should speak directly with your Medicare representative before having cataract surgery to determine the total cost of your operation.
Most health insurance providers consider cataract surgery to be medically necessary, therefore they will cover at least a portion of the costs associated with standard cataract surgery. 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.
Policies vary widely from one insurance provider to the next. Here are some questions you should ask your health care representative regarding cataract surgery:
Centers for Medicare and Medicaid Services. MEDICARE VISION SERVICES. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/visionservices_factsheet_icn907165.pdf.
Ma, Yingyan et al. “Cost-Utility Analyses of Cataract Surgery in Advanced Age-Related Macular Degeneration.” Optometry and vision science : official publication of the American Academy of Optometry vol. 93,2 (2016): 165-72. doi:10.1097/OPX.0000000000000772
“History of Cataract Surgery.” EyeWiki, 19 Mar. 2020, www.eyewiki.aao.org/History_of_Cataract_Surgery.
Boyd, Kierstan. “Cataract Surgery.” American Academy of Ophthalmology, 15 May 2020, www.aao.org/eye-health/diseases/what-is-cataract-surgery.
“MIPS 2019-Cost: The Routine Cataract Surgery With IOL Implantation Measure.” American Academy of Ophthalmology, 18 May 2019, www.aao.org/eyenet/article/mips-2019-cost-routine-cataract-surgery-with-iol.
Venkatesh, Rengaraj, et al. “Carbon Footprint and Cost–Effectiveness of Cataract Surgery.” Current Opinion in Ophthalmology, vol. 27, no. 1, 2016, pp. 82–88., doi:10.1097/icu.0000000000000228.
Nandigam, Kiran, et al. “Cost Analysis of Objective Resident Cataract Surgery Assessments.” Journal of Cataract & Refractive Surgery, vol. 41, no. 5, 2015, pp. 997–1003., doi:10.1016/j.jcrs.2014.08.041.