A cataract (the clouding of the eye’s lens) can occur for a variety of reasons, although most are related to the aging process. Cataract surgery is one of the safest and most successful surgeries (of any kind) performed today. Fortunately, the majority of the surgery cost will usually be covered by health insurance.
Private Health Insurance
In most instances, private health insurance policies will cover some, if not all, of the cost for doctor’s visits, facility fees, anesthesia, the traditional monofocal intraocular lens (see below), the surgery itself, and your follow-up care.
Depending on the terms of your specific policy, you may be responsible for the deductible and a co-payment (a percentage of the allowable expenses). You will also be responsible for the co-payment for any medications your doctor prescribes after surgery. If you have no prescription drug insurance coverage, these expenses would be paid out of your pocket or by a supplemental insurance policy, if you have one.
When you schedule cataract surgery with Eye Consultants of Pennsylvania, a member of our staff will review your insurance coverage and advise you up front what, if any, out-of-pocket expenses you can expect to have to pay.
Medicare and Cataract Surgery
If you are eligible for Medicare coverage, the cost of cataract surgery, including the traditional monofocal intraocular lenses (see below), is covered under Medicare Part B. You will typically be responsible to pay a 20% coinsurance for the surgery plus your Medicare deductible, and will be required to pay for any expenses not covered by Medicare.
Prescription medications required after surgery, such as eye drops, are partially covered by Medicare Part D, so you may be responsible for a co-payment. Medicare will also cover part of the cost of one pair of prescription glasses and standard frames, or contact lenses, if you need them following cataract surgery.
Many Medicare beneficiaries also have supplemental insurance to cover their out-of-pocket expenses. If you have this type of coverage, please be sure to bring this to the attention of our staff.
Cataract Lens Options
Most private health insurance plans and Medicare will cover only the cost of traditional monofocal intraocular lenses. These traditional lenses will give you good distance vision, such as for when you’re driving. For near or intermediate vision, such as reading or using the Internet, most people with monofocal lenses will need to wear glasses after cataract surgery.
To correct eyesight at all distances and reduce the need for reading glasses after surgery, there are other “Hi-Tech” or premium lens options with advanced optics that can focus in ways that standard monofocal lenses cannot.
- Multifocal lens: This lens is designed to provide excellent, clear vision at different distances – near, far, and everywhere in between – often eliminating the need for glasses. It can be the optimal choice for people who have active lifestyles and find it inconvenient to wear glasses.
- Toric lens: A Toric lens corrects astigmatism and can help patients who have worn glasses their entire lives to see much more clearly in the distance, with less reliance on glasses. You may, however, still need glasses for the best up-close vision. There are several different FDA-approved toric lenses.
- Accommodating lens: This type of lens flexes as you use the focusing muscles inside your eye. The flexing and focusing is called “accommodating.” It can help you focus at different distances and may eliminate the need for glasses for up-close vision.
There are a variety of eye conditions that may make you a better candidate for one lens versus another. For the best results, the cataract specialists at Eye Consultants of Pennsylvania will help you decide which of the Hi-Tech lenses is best for your eyes based on your priorities and lifestyle.
If you choose a Hi-Tech intraocular lens, such as a Toric lens, you will be responsible for paying the additional cost (above the cost of a standard monofocal lens) out of your pocket. They are generally not covered by private insurance companies or Medicare.
The cost of cataract surgery should not deter you from regaining clear vision. Our doctors and staff will work with you to determine what is best for your eye health and your budget.
Call us today to schedule an evaluation. For an appointment, call toll-free 1-800-762-7132.