Paying for laser cataract surgery requires knowing which insurance can help you. Here is a beginner’s guide on Medicare coverage for this procedure.
Did you know that your cataract risk increases every 10 years beginning at age 40? The National Eye Institute states about 50 million Americans will have cataracts by 2050.
Modern cataract surgery began in 1967. Laser cataract surgery became an option between 1995 and 1997.
You may wonder if Medicare pays for this surgery. Read the following guide to learn more.
Types of Surgery for Cataracts
Phacoemulsification is the “traditional” cataract surgery. The surgeon makes a small incision in the cornea and opens the capsule around the lens. Sound waves break up the cloudy lens and then the surgeon removes the pieces.
The surgeon replaces your damaged lens with an intraocular lens (IOL). Instead of stitches, a special self-sealing liquid closes the incision.
Laser Cataract Surgery
Laser procedures begin with a camera/ultrasound device mapping the eye surface. A computer receives this information. It tells the laser the precise size, depth, and location for incisions.
This makes the openings into the cornea and the capsule around the lens. The surgeon may also use laser-generated energy to soften the cataract. An ultrasound probe breaks up and removes the lens and inserts an IOL.
Cost of Surgery for Cataracts
The average cost for traditional cataract surgery is from $3,000 to $5,000 per eye. Laser cataract surgery costs about $4,000 to $6,000 per eye. This is the cost without any coverage by Medicare or private insurance.
Different Medicare Plans
“Original Medicare” includes Part A and B. This federal program offers traditional fee-for-service coverage.
If you’ve paid Social Security taxes and Medicare for at least 10 years, Part A is free. Part B has a monthly fee based on your income.
You must use Medicare-approved doctors and other treatment facilities. Medicare covers 80% of approved charges and you pay the remaining 20%. You will have a deductible for each enrollment period.
You have the option to choose Medicare Advantage, called Part C, which is a private plan. You may buy Part C in addition to Original Medicare. The Part B premium will still apply.
Medicare Advantage Plans have different costs, restrictions, and rules.
Options for Insurance Coverage
There are several insurance options to help pay fees not covered by Medicare. These may include:
- Medicaid for those who qualify
- Medicare savings programs
- Group health coverage via your employer
- VA benefits
- TRICARE for Life
Another choice is to purchase a Medigap coverage plan. You may choose from 10 different plans named by letter codes from A to N. Each plan has its own rules and costs.
One common choice is Medicare Part D. This covers prescription medications.
Medicare Coverage for Laser Cataract Surgery
Medicare offers coverage for laser cataract surgery. Specific coverage depends on which Medicare plans you have and any pre-existing conditions.
The level of coverage varies based on where you have the procedure. Examples include a hospital, clinic, or surgery center. Medicare requires that the surgery be medically necessary.
Medicare covers laser-assisted cataract surgery for individuals with cataracts and astigmatism. During the cataract surgery, specific incisions in the cornea reshape it and correct astigmatism.
You may also choose laser surgery and have a toric or multifocal IOL inserted to correct astigmatism. If these conditions aren’t met, the surgeon can’t offer or bill for laser surgery.
Do You Want More Information About Medicare?
This article provided an overview of Medicare coverage for laser cataract surgery. It’s important to spend time researching all options before making a decision. Our site provides accurate, non-biased information about Medicare plans.