Welcome to our Patient Guide to everything you need to know about Medicare and Cataract Surgery. In this article, we’ll answer common questions such as:
- Does Medicare Cover Cataract Surgery?
- What Does Medicare Cover For Cataract Surgery?
- Does Medicare Pay For Cataract Surgery With Astigmatism Correction?
- Does Medicare Cover Laser Cataract Surgery?
We’ll answer these questions and more so that you’ll be prepared before discussing things with your surgeon and their surgical counselors. Let’s get started!
Does Medicare Cover Cataract Surgery?
First and foremost, we need to answer this common question: Does Medicare cover cataract surgery?
Good news… The answer is ‘Yes’!
However… That’s just the short answer… There are a few additional things to consider because while Medicare typically covers at least some of cataract surgery, it often doesn’t cover all of it. This commonly results in patients having some out-of-pocket expenses.
Cataract surgery has advanced tremendously over the last few decades. As technology has advanced, making surgery safer and achieving better vision outcomes than ever before, medical insurance plans, such as Medicare have not extended their coverage for these new technologies.
So while it is true that Medicare does cover basic manual cataract surgery for any type of cataracts, in the next section we’ll discuss the details of exactly what it covers, and what it doesn’t cover.
What Does Medicare Cover For Cataract Surgery?
Medicare covers a basic version of cataract surgery, performed by hand, with a basic lens implant, that is not customized to your eyes.
After basic cataract surgery, patients should expect to need bifocals and trifocals for their best vision.
This is because Medicare is a type of “medical insurance”.
Medical insurance differentiates itself from vision insurance plans. Medical insurance draws a line saying that removal of the cataract, and replacement with a basic lens implant fulfills their responsibility as a medical insurance provider, and if a patient would like to be free from glasses, either with a modern lens implant, laser vision correction, or glasses, then that is the patient’s responsibility.
As a result, to achieve better vision after surgery, Medicare patients have the option of adding these non-covered services to their cataract surgery at an out-of-pocket expense.
There are different names that practices use to describe these non-covered services.
If you are considering a modern lens implant or laser cataract surgery to achieve safer surgery and better vision afterwards, it’s important to remember that Medicare will still be paying their portion of the surgery. Any out-of-pocket payment is made in addition to what Medicare covers.
In the next sections, let’s get into specific examples of the services you’ll have the option of choosing for your cataract surgery, and discuss them in the context of Medicare.
Does Medicare Pay For Cataract Surgery With Astigmatism Correction?
Cataract surgery with astigmatism correction has been available for decades, and modern techniques for this are extremely accurate & consistent.
In every single patient in America who gets a pair of glasses or contact lenses has their astigmatism managed.
It would be gross malpractice for an eye doctor to prescribe glasses or contact lenses without measuring a patient’s astigmatism or prescribing lenses without considering a patient’s astigmatism.
This is because astigmatism is a fundamental part of the prescription that must be addressed for the eye to see clearly.
So why would any patient having cataract surgery allow for the “wrong lens implant” to be put inside their eye without managing their astigmatism?
The position of medical insurance on this topic is that astigmatism correction is a vision problem that can be fixed with glasses or contact lenses, and, therefore, is not their responsibility to cover.
As a result, patients who only have the basic lens implant are missing out on a great benefit of modern cataract surgery. Specifically, they are missing out on freedom from bifocals and trifocals for the rest of their life.
Whenever any type of surgery is considered, patients and their doctors should discuss the risks, benefits, and alternatives of the available treatment options. Both doctors and patients seek to maximize the benefits of surgery while reducing the risks.
Astigmatism correction, such as during cataract surgery with toric lens implants, adds significant benefit by achieving superior postoperative vision for patients, without adding serious risk, if any risk at all, to the procedure. By choosing astigmatism correction at the time of surgery, most patients are improving the risk-benefit ratio in their favor.
The only reason not to pursue astigmatism management is cost. Of course, cost is a factor, and every patient needs to consider their own personal financial situation.
When considering the out-of-pocket cost of astigmatism correction, it’s important to also consider the cost of bifocals and trifocals. Typically, after cataract surgery, one’s glasses prescription does not change. So if you achieve freedom from glasses and contact lenses, it is typically for the rest of your life.
However, if you do not have your astigmatism managed, and require bifocals or trifocals, these glasses can be expensive, and typically need to be replaced every 2-3 years. A “no-line bifocal”, also known as a “progressive bifocal”, can be very expensive, and after factoring the replacement cost of a new pair every 2-3 years, it doesn’t take long before choosing astigmatism management becomes a better long term financial decision for many patients.
Does Medicare Pay For Multifocal Lens Implants?
If you’ve read the previous section about astigmatism correction, then this one will be very similar.
Just as Medicare and other medical insurance companies do not consider “astigmatism management” to be a covered service, similarly, they do not consider “presbyopia management” to be a covered service.
Ultimately, presbyopia is the diagnosis that multifocal implants treat.
Presbyopia is the name given to the condition that naturally occurs with aging in which the natural lens stiffens, losing its ability to provide a range of vision without bifocals or reading glasses.
Monofocal lens implants are similarly stiff, and do not have the advanced optics required to provide patients the range of vision necessary to be free from reading glasses.
To address presbyopia at the time of your cataract surgery, there are a few options, one of which is implanting a multifocal lens implant.
The goal of multifocal lens implants is to achieve freedom from glasses for both distance and near vision activities.
Just like with astigmatism management, Medicare and other medical insurances do not cover the cost of these modern lens implants. They will still cover the other aspects of the surgery, but patients should expect an out-of-pocket expense if they select a multifocal implant.
Does Medicare Cover Laser Cataract Surgery?
You may be noticing a theme here as we continue discussing modern technology used in cataract surgery.
Just like the technology used to fix astigmatism and presbyopia, laser cataract surgery is not covered by medical insurance.
Laser cataract systems are guided by complex computer and imaging systems. The first step of a laser cataract procedure is taking high-resolution images of the eye. After obtaining these images, computer software identifies the structures and landmarks for where laser treatment will be applied. Under the guidance of these computer systems, the laser is then applied, performing steps of the procedure with a precision and consistency that the human hand can’t match. It is common to use laser cataract systems to correct astigmatism as well.
Medical insurance does not consider the advanced imaging that is a necessary part of the laser procedure to be covered, or any associated astigmatism management or presbyopia management.
Patients who are interested in laser cataract surgery should expect to pay an out-of-pocket fee for laser cataract surgery.
Many patients are disappointed when they learn that Medicare or other medical insurance plans do not cover several modern technologies that result in benefits for their vision. However, it’s important to remember in these situations that Medicare typically does still cover much of it, including pre-operative & post-operative office visits, anesthesia fees, surgical center fees, and the basic parts of the procedure, such as removing the cataract. However, like so many areas of medicine, technology has made cataract surgery better, and to have these benefits you should expect to pay an out-of-pocket fee.
If you are in need of a cataract surgeon near you, check out our doctor finder map here.