Your Guide to Medicare and Cataract Surgery: What You Need to Know

Without health insurance, the cost of cataract surgery can range from $3,000 to $6,000. While some facilities may offer a payment plan to make it more affordable, many Americans need health coverage to mitigate the cost. 

Americans 65 and older are eligible for Medicare Parts A and B. Individuals with certain disabilities, End-Stage Renal Disease, or ALS are eligible for Medicare before their 65th birthday. Medicare Part A (hospital insurance) and Part B (medical insurance) offer affordable, comprehensive support for a wide range of medical issues. 

Individuals who have Medicare Part B can receive financial support for cataract surgery. However, the amount of support they receive will depend on several factors. In most cases, Medicare Part B will cover 80% of costs related to cataract surgery if performed in an outpatient facility. If the surgery occurs in an in-patient hospital setting, Medicare Part A may cover some of the costs. 

Medicare beneficiaries may also qualify for an implant known as intraocular lenses IOL which are used to replace your natural lenses impacted by cataracts. Those with Original Medicare are also eligible to receive one pair of prescription eyeglasses or contact lenses. 

In some cases, cataract surgery may not offer lifetime corrective support. YAG laser capsulotomy (also known as secondary cataract) is a follow-up procedure that can get rid of recurring symptoms. Original Medicare will cover all necessary exams, the procedure itself, and a year of follow-up care.

Original Medicare beneficiaries are expected to pay 20% of the copay plus deductibles, physician fees, and medication costs. The exact out-of-pocket expenses will depend on your Medicare Supplemental plan (if you have one), how long the surgery took, previous medical conditions, potential complications, and the type of surgery. 

Medicare Supplemental Insurance (Medigap) is designed to offer additional financial support to those with Original Medicare. This includes out-of-pocket costs due to deductibles, copayments, and coinsurance. This includes potential costs after the deductible is met such as the surgery itself and follow-up costs.

Medicare Advantage plans offer specific coverage outside of Medicare Parts A and B. Also known as Medicare Part C, Medicare Advantage is offered by private insurance companies rather than the federal government. 

Private insurance plans can vary greatly, but those with a Medicare Advantage plan will not pay more than 20% of the total amount you’d pay with Original Medicare. However, the cost of deductibles and copayments will depend on your provider and will differ from Original Medicare.  In most cases, your Medicare Advantage plan will have a reasonable co-pay that you will be responsible for.

Those with a Medicare Advantage plan should find a surgeon within their network to keep costs as low as possible. Choosing an out-of-network surgeon may cause you to pay for cataract surgery without assistance. 

Much like Original Medicare, Medicare Advantage plans will also cover YAG laser capsulotomies if they are required after a cataract surgery.

Before setting a date with your doctor, be sure to verify that your particular health insurance will cover cataract surgery. This includes Original Medicare, Medicare Advantage, and Medicare Supplemental Insurance (Medigap). 

Feel free to contact us at 480-331-7974 and request to speak to one of our health insurance professionals. They will help you understand your specific plans and the benefits you are eligible for. You can also learn more about Medicare Part B, Medicare Advantage – Medicare Part C, and Medicare Supplement Insurance – Medigap.

Cataracts impact millions of Americans every year. This condition causes the lenses in our eyes to become cloudy, making it difficult to drive, read, and safely handle other day-to-day activities. Cataract surgery is a safe and effective procedure that replaces cloudy natural lenses with intraocular lenses. 

Having access to Original Medicare, Medicare Advantage, and/or Medicare Supplement Insurance makes cataract surgery more affordable. While these insurance plans are not able to cover all costs, they can cover 80% or more depending on a variety of factors. 

Are you interested in learning more about Medicare? Do you want to find out if you are eligible for Original Medicare, Medicare Advantage, and/or Medicare Supplement Insurance? If so, help is here!

At Insurance Professionals of AZ, we help you find an affordable medicare plan that meets all of your needs. We know how difficult it is to navigate the ever-changing world of health care. That’s why we take you through the process step by step, educating you about all aspects of Medicare, the role of private insurance, and so much more. 

 Insurance Professionals of AZ is an established part of the Arizona community. We believe that our clients’ needs come first. That’s why we’ve devoted ourselves to helping you find the best possible plan at the cheapest cost to you. 

Are you ready to get started with Medicare Insurance AZ? Call us at 480-331-7974