Medicare Cataracts with Medicare Cataract Coverage

Coulpe with Medicare Cataract Coverage for Medicare Cataracts

Medicare Cataracts are Covered by Medicare when Medically Necessary

Medicare cataracts are included in standard Medicare coverage if they are deemed “medically necessary.”

Cataracts develop as the lens inside your eye becomes dysfunctional and cloudy over the course of your life. They start developing almost as soon as you are born and progress slowly until they bother your vision enough that cataract surgery is needed to restore your vision.

The majority of cataracts become bad enough or “ripe” during the Medicare years so the majority of cataracts are Medicare cataracts.

Does Medicare cover Cataract Surgery?

Medicare does cover medically necessary cataract surgery. They define medically necessary as vision 20/50 or worse with some lifestyle complaint of blurry vision. If your vision is better than 20/50, you may still qualify for cataract surgery if 1. your vision declines (20/50 or worse) when bright lights are shined in your eyes AND 2. You notice trouble from glare in your daily life. The bright light test is intended to duplicate the bright light and glare that would occur with a headlight shining in your eyes while driving at night.

Medicare cost for Cataract Surgery

The Medicare cost for cataract surgery depends on whether you have your Medicare cataract surgery performed in a hospital or an ASC. Medicare sets the rate for cataract surgery and allows hospitals to charge more for Medicare cataracts than an ASC. Having your cataract surgery performed at an ASC that specializes in Medicare cataract surgery is a good way to decrease the cost for cataract surgery. The cost of Medicare cataracts surgery is particularly high in university and rural hospitals.

Medicare Cataract Coverage

Medicare cataract coverage is the same as for all the other areas of Medicare. They cover 80% of Medicare cataract surgery after you have met your deductible. If you have a supplement, they cover the remaining standard expenses as long as you have met your deductibles.

A single vision lens implant is included in standard Medicare cataracts surgery at no additional out of pocket expense.

Advanced technology lens implants and laser cataract surgery are upgrades that are not included in Medicare cataract coverage. If you elect laser cataract surgery or an advanced technology IOL, Medicare pays the standard cataract surgery fees, but you would have some additional out of pocket expenses to cover the laser part of the procedure.

I provide some specific examples of this in my blog post on “The Cost of Cataract Surgery.”

Couple on Bike with Medicare Cataract Coverage for Medicare Cataracts

You choose Cataract Removal when it is taking away something you want back.

When should I have my cataracts removed?

You should have your cataracts removed when they are taking something away from your life that you want back.  Those that have to drive a lot at night often have their cataract removed at a younger age while those that don’t mind giving up night driving can usually put off their Medicare cataracts surgery for an extra year or so.

How do I choose a Cataract Surgeon?

As you consider who you will have remove your cataract surgeon, it is important to find out if they accept Medicare.  Fortunately, most cataract surgeons perform Medicare cataract surgery.  It is well documented that surgeons with more experience tend to have less complications.  It is a good idea to find out which surgeons in your area perform the most Medicare cataract surgery.  Then ask your friends, your eye doctor, and your primary care physician whom they recommend.  Finally, have an appointment with the recommended doctor to see if you are comfortable with how they will treat you.

If I can help you with any other questions about Medicare cataract surgery or Medicare cataract coverage please schedule a time to meet with me or post a comment.

 

 

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