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Medicare Coverage for Cataract Surgery

Normally, the lenses of your eyes are clear. But if it’s not, it could be cataracts. Cataracts are like clouds in the lenses of your eyes. Because most develop slowly, at first you might not notice a difference in your eyesight. Eventually cataracts will make your lenses more and more cloudy, eventually interfering with your vision. Cataracts can appear in one eye or both. If you develop it in both eyes, the progression of the cloudiness does not necessarily move at the same speed. Your eye or eyes will become more and more cloudy (or “opaque”) because the cataracts are blocking light from reaching the retina.

Risk factors:

  • Getting older
  • Diabetes
  • Lots of exposure to sunlight
  • Smoking
  • Obesity
  • High blood pressure
  • Previous eye injury or eye surgery
  • Long-term use of certain medications
  • Drinking large amounts of alcohol
  • Some genetic disorders

Symptoms:

  • Cloudy or blurry vision
  • Dim vision, especially at night
  • Sensitivity to light and glare
  • Needing brighter light for reading
  • Seeing “halos” around lights
  • Colors fade or appear yellow
  • Double vision in one of your eyes

Cataract surgery and Medicare coverage

Doctors often recommend either inpatient or outpatient surgery to correct cataracts, so it’s important to know how Medicare covers this. The surgery removes your natural lens and replaces it with an artificial lens. So you won’t have to worry about a new cataract forming. If you are having surgery for one eye, a cataract could still develop in your other eye. In that case, you may need a second surgery. If you have cataracts in both eyes, you will have surgery on one eye, and then – after some recovery time – your ophthalmologist will decide whether you still need surgery on your other eye.

Outpatient is typically covered under your Medicare Part B (medical) benefits, and inpatient is generally covered by your Medicare Part A (hospital) benefits. Remember to write down questions to ask your doctor about the surgery. It’s a good idea to call a Medicare specialist also to know which costs are covered and which costs you may have to pay out-of-pocket.

Note:

Medicare covers inpatient or outpatient surgery to remove cataracts. However, Medicare only pays expenses directly related to the cataracts.

For example, if you have another condition that is being treated during your cataract surgery, you will be billed separately for the parts of the treatment not directly related to the cataracts.

Medicare will also cover approved fees from your ophthalmologist and facility. Medicare covers an eye exam prior to surgery as well as anesthesia during surgery. You may be responsible for other costs, such as specialized lenses. Remember that you may be responsible for your Part B deductible as well as copays and/or coinsurance. You and your doctor will discuss all of this before your inpatient or outpatient surgery.

Note:

A Medicare Advantage (Part C) plan or a Medicare Supplement (Medigap) plan may give you more coverage and less out-of-pocket costs for your cataract surgery.

For example, if you have another condition that is being treated during your cataract surgery, you will be billed separately for the parts of the treatment not directly related to the cataracts.

Be sure to talk to your doctor about the treatment and costs related to the treatment of your cataracts. Also, if you have Original Medicare, call 1-800-MEDICARE (1-800-633-4227) (TTY: 711) for details. If you have a Medicare Advantage plan or Medicare Supplement plan, call a customer service specialist at your private insurance company.