Cataracts, a leading cause of vision loss, are common in older adults, especially those over 65. Fortunately, Medicare and Medicaid offer coverage for cataract surgery under specific conditions.
Medicare and cataract surgery
Medicare, particularly through Part B, typically covers cataract surgery as it is considered a medically necessary procedure. This includes both traditional surgical methods and laser-assisted options. Medicare also covers postoperative care, including one pair of eyeglasses or contact lenses after surgery involving an implanted intraocular lens (IOL).
However, patients are responsible for certain costs:
- Deductibles and coinsurance: Patients must meet the Part B deductible and pay 20% of the Medicare-approved amount.
- Advanced lens costs: While Medicare covers monofocal lenses, advanced options like toric or multifocal lenses often incur out-of-pocket costs.
The Centers for Medicare & Medicaid Services (CMS) notes that coverage remains consistent for traditional and laser-assisted cataract surgeries, but additional imaging or advanced lens-related services may require extra payments
Does Medicare cover laser-assisted cataract surgery?
Yes, Medicare covers laser cataract surgery, but only for procedures deemed medically necessary. According to the Centers for Medicare & Medicaid Services (CMS), the coverage does not vary between laser-assisted surgery and traditional methods, but extra services associated with advanced technology lenses are not covered.
Medicare and post-surgery glasses or contact lenses
After cataract surgery, Medicare Part B provides coverage for one pair of glasses or contact lenses. This is limited to standard options and must be obtained from a supplier enrolled in Medicare. Patients pay 20% of the cost for these items.
Medicaid coverage for cataract surgery
Medicaid coverage varies by state, but it generally includes cataract surgery when it is medically necessary. Unlike Medicare, Medicaid may also assist with additional costs, such as transportation to and from appointments. Patients are advised to consult their state Medicaid program for specific details regarding eligibility and out-of-pocket expenses.
Eligibility requirements
Both Medicare and Medicaid require cataract surgery to be medically necessary. This means the procedure must be prescribed by a qualified healthcare provider to address issues like significant vision impairment that interferes with daily activities.
For Medicare beneficiaries, eligibility begins at age 65, with some exceptions for younger individuals with disabilities. Medicaid eligibility is determined based on income, residency, and other state-specific criteria.
What to consider before surgery
- Know your Ccsts: Contact your provider or facility for an estimate of surgery costs, including pre- and post-operative care.
- Supplemental insurance: If you have a Medigap or Medicare Advantage plan, understand how it affects your coverage.
- Plan for aftercare: Determine whether you’ll need post-surgery glasses or other treatments.
- Verify coverage: Check with your state Medicaid office or Medicare provider to confirm eligibility and coverage for your specific needs
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Tips for managing costs
To minimize out-of-pocket expenses:
- Consult your providers. Confirm costs with your doctor and hospital beforehand.
- Supplemental insurance: Consider Medigap or Medicare Advantage plans, which may offer broader coverage.
- State resources: Explore Medicaid and state-specific assistance programs if you qualify.
How to confirm coverage
- Visit MyMedicare.gov to check your plan’s details.
- Review your Medicare Summary Notice (MSN) for cost-sharing and deductible information.
- Contact state Medicaid offices for eligibility and coverage specifics
