How Much Does Cataract Surgery Cost and Is It Covered By Insurance?
Cataract surgery is one of the most commonly performed eye surgeries in the United States, but it can be expensive if it is not covered by insurance. Without private insurance or Medicare, you can expect an out-of-pocket expense anywhere from $3,000 to $7,000 per eye. With insurance or Medicare, traditional monofocal cataract surgery is covered, but you may incur expenses in copayments, medication costs. Specific costs will vary depending on the type of lens, any additional underlying eye issues, and the surgical technique. Openly discussing this with your surgeon before scheduling your surgery is imperative to avoid any hidden costs. It is also helpful to speak to your insurance or Medicare representative to fully understand your coverage.
What Is Cataract Surgery?
Cataract surgery is a surgical eye operation performed by an ophthalmologist to remove your eye’s lens when it is cloudy. A normal, healthy lens is clear, while one that is damaged is cloudy in appearance. During surgery, your damaged natural lens is removed and replaced with a clear artificial lens.
Cataract surgery is covered by insurance and Medicare, but specific costs will vary depending on your surgeon, the lens used, and surgical technique. You will have some out-of-pocket expenses with copayments, deductibles, and medications. Without insurance, the cost of cataract surgery on both eyes is upwards of $6,000 to $12,000. The cost includes the surgery, implantation, and consumable surgery equipment, as well as technical, professional, and surgery center fees. Most surgeons will offer payment plans if you have to pay out of pocket. You can use a health savings account (HSA) to pay out-of-pocket expenses.
Type of Procedure
Four main surgical techniques are used for cataract surgery. Phacoemulsification is the most common technique used to remove a cataract. This is utilized during a standard cataract procedure and is covered by private insurance and Medicare. Extracapsular cataract extraction and Intracapsular cataract surgery are both less commonly used techniques and involves the surgeon making a larger incision in the eye to remove the lens in one piece. These technique may result in more complications and slower healing than surgeries that involve a smaller incision. Laser-assisted cataract surgery involves using optical coherence tomography. Laser cataract surgery is the newest technique and is generally not covered 100% by private insurance or Medicare.
Type of Lens Implanted
There are multiple options for lenses. The most widely used are fixed-focus monofocal lenses, accommodating monofocal lenses, toric lenses, and multifocal lenses. Private insurance and Medicare typically cover monofocal lenses, but each toric lens will start at about about $1,500, and specialized lenses will start at about $3,000 a piece. Specific specialized lenses such as presbyopia lenses and astigmatism lenses will have additional costs.
Other Underlying Eye Conditions
During cataract surgery, astigmatism can also be fixed. If you have this combination procedure, then a special intraocular lens called a toric lens must be used. The severity of preoperative astigmatism will determine whether it can be corrected completely or you will still need glasses after the procedure. Utilizing a special toric lens will add additional costs to your procedure that your personal insurance or Medicare might not cover. Specific costs will depend on the surgeon and their billing costs.
It is important to discuss with your healthcare provider potential out-of-pocket costs for the procedure. Unfortunately, if you have astigmatism and a cataract, only one lens can be implanted.
All major private insurances cover cataract surgery. Most insurances will cover traditional monofocal lens implants; however, if you are interested in a multifocal lens implant, there may be out-of-pocket expenses. These expenses will depend on your insurance.
Before surgery, speak to your insurance provider and ask questions regarding the financial aspects of the surgery. Some questions to ask might be:
- How much is my copay?
- Is anesthesia covered?
- Is the surgical center covered?
- Is the anesthesia group at the surgery center covered?
- Do I need a pre-approval?
- Is there a specific surgeon I need to use?
- Are postoperative appointments covered?
- Are post-surgery medications used?
Cataract surgery falls under Medicare Part B since it is usually an outpatient procedure. Medicare Part B covers doctors’ services and outpatient procedures. Medicare covers the cost for removing the cataract, monofocal lens implants, and one set of prescription contact lenses or eyeglasses following surgery. This is considered standard cataract surgery. If you are not sure about your exact Medicare coverage and available options, speak to a Medicare representative before cataract surgery. If you are interested in eliminating the use of glasses or contact lenses after the procedure, there may be additional costs to upgrade to a different artificial lens. It is important to discuss your Medicare coverage with your surgeon to know what technique they will be doing so there will be no payment surprises.
Flexible or Health Spending Account
A flexible spending account (FSA) is a special account you put money into that you use to pay for certain out-of-pocket healthcare costs, including surgery and medications. You will contribute money from your paycheck before income taxes are taken out. This means the money in the FSA is not subject to taxes. You can use your FSA for the insurance deductible, copayments, and qualified medications. By utilizing pre-tax money, you will be saving money. You will be given either a debit card to pay for medical expenses, or you will have to submit receipts and documentation for reimbursement.
Determining which surgical technique and lens are best for you depends on your goals after surgery. If you are OK wearing glasses or contact lenses, then undergoing standard cataract surgery using a monofocal lens would be a good option. This surgery is covered by both private insurance and Medicare, less a copayment and deductible. If you do not want to wear contacts, then upgrading to a different lens or a more advanced surgical approach may incur additional out-of-pocket costs. Knowing your financial abilities is important when discussing surgical options with your healthcare provider. If you have the ability to pay more money out of pocket, then there may be additional options available to you. If you do not have financial freedom regarding the surgery, the standard cataract procedure is extremely safe and effective. Just because a specific technique or lens costs more money does not mean that it is a better approach or product. Depending on your eye condition, you may need something different than the standard cataract procedure. There may not be any other options. If that is the case, speak to your surgeon and the insurance company to determine specific out-of-pocket expenses.