Cataracts are more common as you get older. By age 65, about 30% of Americans have some vision impairment from cataracts in one or both eyes. By age 80, over 50% have cataracts. Cataract surgery is currently the only effective treatment to restore your sight. The good news for Medicare patients is that Medicare covers cataract surgery.
How is cataract surgery performed?
Most of the time, cataract surgery is an outpatient procedure. You’ll most likely be awake during the surgery, but your doctor may give you medication to help you relax. Cataract surgery takes about an hour to perform.
During cataract surgery, your doctor removes the clouded lens and replaces it with an artificial implant. There are two methods for removing the clouded lens:
- Phacoemulsification: The surgeon inserts a tiny probe into the lens and uses ultrasound waves to break up the cataract. He then “vacuums” out the particles and places the artificial lens over the lens capsule. The incision in your cornea is very small; you may or may not need stitches to close it up.
- Extracapsular: If you aren’t a good candidate for phacoemulsification, your doctor will make an incision in the cornea and lift out the lens in one piece before placing the lens implant. Because the incision is larger in this procedure, you’ll definitely need stitches in your cornea.
After cataract surgery
Your eye might itch a little after the surgery, and some people have mild discomfort. But look on the bright side: You’ll see improvement in your vision right away, although your vision might be a bit blurry the first day or two as your eye heals.
You may need to wear an eye patch for a while after cataract surgery and use special eye drops to prevent infection and keep your eye pressure under control. Sometimes, the doctor can inject these medications during surgery so you won’t have to use eye drops.
Cataract surgery is successful for the vast majority of people. A small number of people go on to develop a second cataract in the treated eye, but it won’t require a second surgery. These post-surgical cataracts are treated with a special laser right in the doctor’s office; the procedure takes about five minutes.
How much does cataract surgery cost?
In the Dallas-Fort Worth area, cataract surgery, including your doctor visits after the surgery, costs about $3,500 per eye  if you don’t have insurance.
The total cost of cataract surgery could be more or less depending on what type of intraocular lens (IOL) your doctor uses, whether the doctor uses a laser during the procedure and whether your cataract surgery is done in the hospital or an outpatient surgery center.
It’s important to talk over your choice of IOL before you have cataract surgery with Original Medicare. Medicare covers the cost of a monofocal lens, but your doctor may suggest a premium IOL if you have astigmatism or presbyopia (farsightedness). If you choose one of these premium lenses, expect to pay $1,000 or more out-of-pocket for the upgrade.
How does Medicare cover cataract surgery?
Medicare, whether you have Original Medicare (Part A and Part B) or Medicare Advantage, covers costs associated with cataract surgery. Specifically:
- Part B covers the cost of the outpatient surgery center, doctor’s fees, and other expenses associated with outpatient surgery. Once you meet the Part B deductible, Medicare pays 80% of allowable charges.
- Part A covers your hospital stay if your cataract surgery takes place in the hospital instead of an outpatient facility. You pay a separate Part A deductible if your cataract surgery requires an inpatient stay.
- Part D pays for any drops and medications your doctor prescribes before and after your cataract surgery.
Coverage from supplemental plans
If you have a Medigap plan, your plan covers its share of any costs for services approved by Medicare. For example, your plan will pay the surgeon and facility charges, but it won’t pay any portion of your upgraded lens, if you choose one, because it’s not an item covered by Medicare.
Medicare Advantage is private health insurance, so each plan treats cataract surgery differently. Many pay 100% of allowable charges after you pay an outpatient surgery copayment. You may also have an annual deductible for your Medicare Advantage plan.
If you have Medicare Advantage, your plan may pay some of the costs if you choose to upgrade your IOL. Talk it over with your doctor and contact your plan for an estimate if your doctor recommends a premium lens. That way you’ll avoid any unpleasant surprises with your bill.
The bottom line about cataract surgery and Medicare
Cataract surgery is one of the most commonly performed procedures for Medicare patients; it’s a safe and effective treatment. Medicare covers a lot of your costs, but it doesn’t cover everything, especially if you choose a premium IOL.
If you have questions about your Medicare coverage and cataract surgery, a Medicare Expert at Boomer Benefits can help you compare plans to get the coverage you need. Cataract surgery is an elective procedure, which means you can schedule it when it works best for you.
If you plan to have cataract surgery this year, it pays to compare Medicare plans in your area so you get the best possible coverage for your financial situation.