More than half of all Americans 80 or older have cataracts or have had surgery to correct cataract healthcare issues.
Cataracts are an eye condition that creates a cloudy area in your eye lens, leading to blurry vision, faded colors, sensitivity to light, and other related problems.
Surgery is the prescribed treatment, but without health insurance, the cost of cataract surgery can be $4,000 or more. Complicated cases such as those involving intraocular lenses (IOLs) for astigmatism or opting for laser cataract surgery can increase your cost.
There are several kinds of cataract surgery:
Medicare, Medicare Advantage Part C plans, and Medicare supplement plans will cover cataract surgery if it is done with traditional surgical techniques or lasers.
Medicare pays for standard cataract surgery for people who are 65 or older. Original Medicare will even pay for corrective lenses if you have surgery to implant an IOL. Under your Medicare Part B benefits, Medicare will pay for one pair of eyeglasses with standard frames or a set of contact lenses.
Medicare Part B benefits only cover the Medicare-approved amount for cataract surgery. You will also have to pay a deductible and a 20% Part B copay.
Medicare Advantage plans out of pocket costs vary based on your premium, deductible, and coinsurance or copayment amount.
Even with Original Medicare, you’ll still have a sizable share to pay. However, Medigap plans can offset some of those expenses, covering the 20% coinsurance payment and other costs Medicare doesn’t cover.
Here’s what you should know about coverages for other vision-related health issues.
Medicare doesn’t cover eye exams for prescription eyeglasses or contact lenses. With Original Medicare, you pay 100% for eye exams for eyeglasses or contact lenses.
However, Medicare will cover an eye exam to diagnose potential vision problems. Your exam is covered even if it turns out you do not have a vision problem.
Some Medicare Advantage plans may offer additional benefits, including routine vision care. You will need to contact specific plans to see what is covered.
Medicare covers some diagnostic and preventive vision screenings in certain cases. For example, Medicare Part B covers a glaucoma screening once a year if you are at high risk for glaucoma. You’re considered high risk for glaucoma if:
The glaucoma test must be given by an eye doctor who is authorized to perform the test in your state. You will pay 20% of the Medicare-approved cost for the screening after you reach your Part B deductible if your doctor accepts the assignment.
Part B covers an annual vision exam to check for diabetic retinopathy. You are covered for this exam if you have diabetes and are enrolled in Medicare Part B.
Medicare covers care related to eye disease or injury. For example, Medicare covers medically necessary treatment for conditions like:
Macular degeneration tests and treatment are covered under Medicare Part B. You are also covered under Part B for medically necessary treatment, including outpatient prescription drugs and injected medications. If you are eligible, you will pay 20% of the Medicare-approved amount for prescription drugs and outpatient services after reaching the Part B deductible.
Medicare covers eye prostheses (artificial eyes) for beneficiaries without an eye or who have eye shrinkage because of congenital disability, vision trauma, or surgery. Polishing and resurfacing of your artificial eye are also covered. Medicare will pay for a replacement once every five years.
Eye problems are prevalent with older Americans. That’s why, with the help of a qualified insurance agent, it is essential to understand your coverage and seek out additional coverage that best meets your needs.
DISCLAIMER: Medi-Solutions Insurance Agency, LLC is not affiliated or endorsed with the Social Security Administration or the Federal Medicare Program. Information is for educational purposes only and should not be construed as an offer of insurance, advice, or recommendation. The information provided is not intended as tax, financial, investment, or legal advice. Please consult legal or tax professionals for specific information regarding your individual situation.
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