Cataract Surgery and Medicare

Cataracts are a common age-related vision problem. According to numbers from the American Academy of Ophthalmology, 24.4 million Americans age 40 or older have cataracts. Half of all people age 75 or older have cataracts. Cataract surgery improves vision through the removal of the clouded lens of the eye. It is safe, effective, and quite routine.

Numerous patients in the greater Philadelphia, PA have contacted Ophthalmology Physicians & Surgeons, PC with questions about Medicare coverage for cataract removal. Dr. Francis J. Clark and his team would like to go over this topic briefly so you have a good understanding of the issues involved.

Will Medicare Cover My Cataract Surgery?

Yes, Medicare will cover your cataract removal surgery, but only if your doctor considered the procedure medically necessary. In regards to cataract surgery coverage, Medicare will cover the pre-exam surgery, the surgery itself, and the surgical anesthesia.

Patients who undergo medically necessary cataract removal will need to pay 20 percent of the Medicare co-insurance for the procedure as well as their Medicare deductible.

If cataract removal is not medically necessary, then Medicare will not cover the procedure.

When Is Cataract Removal Considered Medically Necessary?

In basic terms, cataract surgery is considered medically necessary when the cataracts caused significant vision impairment. In these cases, the vision loss is too severe to be addressed through less invasive means, such as corrective lenses and assertive devices.

Medicare and Lenses After Cataract Removal

Normally, Medicare will not cover the cost of glasses or contacts. However, after cataracts have been removed, Medicare will often cover eyeglasses, contact lenses, and intraocular lenses (IOLs) required to restore vision following the surgery.

Patients will need to pay 20 percent of the Medicare-approved amount plus their Medicare deductible.

Treatments for Less Serious Cataracts

If your cataracts do not significantly impair your vision but do cause cloudiness or minor vision loss, there are treatments available. Generally, these treatments involve the use of corrective lenses or assistive devices

Since Medicare typically does not cover corrective lenses, it’s likely that patients will need to pay for these corrective lenses out of pocket.

Payment Plans and Financing Options for Cataract Surgery

If your cataract treatment is not covered by Medicare, our team can work with you to find an affordable option for your vision needs. We have monthly payment plans and financing options available to help ensure your vision needs are not an undue financial burden.

How Our Eye Care Specialists Can Help

Dealing with insurance companies and getting straight answers about the cost of medical procedures can be complicated. All of our eye care specialists will work with your to ensure you receive the information you need throughout the treatment process. We can answer all of your questions about the surgery itself, and also help you understand the cost and payment options available to you.

Contact an Experienced Eye Surgeon

To learn more about cataracts and your many treatment options, be sure to contact an experienced eye surgeon and vision specialist. You can reach Ophthalmology Physicians & Surgeons, PC in Trappe by phone at (610) 489-7440, in Blue Bell at (610) 272-1211, in Spring House at (215) 542-1522, in Hatboro at (215) 672-4300, in Bethlehem at (610) 868-0130, and in Levittown at (215) 547-1818.

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