Does Medicare Cover Cataract Surgery in 2018?
Yes, Medicare does cover cataract surgery in 2018, provided the surgery is deemed medically necessary and performed by a Medicare-approved ophthalmologist. Coverage typically includes basic monofocal lens implants, with beneficiaries often responsible for deductibles, copayments, and potentially upgraded lens options.
Understanding Cataracts and Their Impact
Cataracts, the clouding of the eye’s natural lens, are a prevalent condition, especially among older adults. This clouding obstructs light, leading to blurred vision, glare, and difficulty with activities such as reading and driving. While cataracts are a common part of aging, they can significantly impair one’s quality of life. Treatment typically involves surgery to remove the clouded lens and replace it with an artificial lens implant. This procedure is one of the most frequently performed and safest surgeries in the United States.
Medicare’s Coverage of Cataract Surgery in 2018: A Detailed Look
Does Medicare cover cataract surgery in 2018? The short answer is yes, but understanding the specifics of that coverage is crucial. Original Medicare (Parts A and B) covers the cost of cataract surgery when deemed medically necessary. This means that an ophthalmologist must determine that the cataract is significantly affecting your vision and daily activities.
Medicare’s coverage typically includes the following:
- Pre-operative eye examination: This examination determines the need for surgery.
- The cataract surgery itself: This includes the removal of the clouded lens.
- Basic monofocal lens implant: A monofocal lens corrects vision at one distance (usually far).
- Post-operative care: This includes follow-up appointments to monitor healing.
- Facility fees: Costs associated with the surgical center or hospital.
Medicare Part A vs. Part B Coverage
It’s important to understand how Medicare Parts A and B play a role:
- Medicare Part A: Covers inpatient hospital stays. If your cataract surgery requires an overnight hospital stay (which is rare), Part A would cover those costs after your deductible is met.
- Medicare Part B: Covers outpatient services, including doctor’s visits, the surgery itself (if performed in an outpatient setting), and durable medical equipment. Cataract surgery is typically performed as an outpatient procedure, meaning Part B is the primary coverage source.
Costs Associated with Medicare Coverage
While Medicare covers a significant portion of the costs, beneficiaries are still responsible for certain expenses. These include:
- Deductibles: In 2018, the Part B deductible was $134. You must meet this deductible before Medicare starts paying its share.
- Copayments/Coinsurance: Typically, Medicare Part B covers 80% of the approved amount for cataract surgery, and you are responsible for the remaining 20%.
- Upgraded Lens Implants: Medicare typically covers the cost of a basic monofocal lens. If you choose a more advanced lens implant, such as a multifocal or toric lens (to correct astigmatism), you will likely have to pay the difference in cost.
- Prescription Eye Drops: You will likely require prescription eye drops after surgery to prevent infection and promote healing. These are usually covered by Medicare Part D, if you have it, subject to its copays and deductible.
Common Mistakes and How to Avoid Them
Many beneficiaries make common mistakes when it comes to understanding their Medicare coverage for cataract surgery. Here are a few and how to avoid them:
- Assuming all lenses are covered: As mentioned, Medicare typically only covers basic monofocal lenses. Discuss your lens options and the associated costs with your doctor before surgery.
- Not understanding the 20% coinsurance: Many people are surprised by the 20% coinsurance cost. Factor this into your budget when planning for surgery.
- Ignoring the need for a Part D plan: Prescription eye drops are a necessary part of post-operative care. Ensure you have a Part D plan to help cover these costs.
- Not checking if the doctor accepts Medicare assignment: Choose a doctor who accepts Medicare assignment to ensure you are not charged more than the Medicare-approved amount.
Choosing the Right Lens Implant
Selecting the right lens implant is a crucial part of the cataract surgery process. Here’s a comparison:
| Lens Type | Distance Correction | Astigmatism Correction | Out-of-Pocket Cost |
|---|---|---|---|
| Monofocal | One fixed distance | No | Generally Covered |
| Multifocal | Multiple distances | Sometimes | Higher |
| Toric | One fixed distance | Yes | Higher |
| Accommodating | Range of vision | No | Higher |
Discuss the pros and cons of each lens type with your ophthalmologist to determine the best option for your individual needs and lifestyle.
Does Medicare Cover Cataract Surgery in 2018? And what if I have a Medicare Advantage Plan?
If you have a Medicare Advantage (Part C) plan, your coverage may differ slightly from Original Medicare. Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare, but they may have different cost-sharing arrangements, provider networks, and prior authorization requirements. Contact your specific Medicare Advantage plan to understand your coverage details.
What is a cataract and how do I know if I have one?
A cataract is the clouding of the natural lens of the eye. Symptoms include blurred vision, glare, halos around lights, difficulty seeing at night, and faded colors. A comprehensive eye exam by an ophthalmologist can determine if you have cataracts.
Does Medicare require a referral to see an ophthalmologist for cataract evaluation?
No, Original Medicare does not typically require a referral to see a specialist, such as an ophthalmologist, for a cataract evaluation. However, some Medicare Advantage plans may require a referral from your primary care physician. Check with your specific plan.
If I choose a premium lens implant, how much will I have to pay out-of-pocket?
The out-of-pocket cost for a premium lens implant will vary depending on the type of lens and your surgeon’s fees. It can range from several hundred to several thousand dollars per eye. Discuss the cost with your surgeon’s office before proceeding with surgery.
Are there any alternatives to cataract surgery?
The only effective treatment for cataracts is surgery. While eyeglasses and stronger lighting can temporarily improve vision, they do not address the underlying problem of the clouded lens.
What is the recovery time after cataract surgery?
The recovery time after cataract surgery is typically relatively short. Most people can resume normal activities within a few days. However, full vision stabilization may take several weeks.
Does Medicare cover the cost of eyeglasses or contact lenses after cataract surgery?
Medicare Part B may cover the cost of eyeglasses or contact lenses after cataract surgery if they are medically necessary to correct vision after the lens implant. However, coverage is limited, and you may be responsible for a portion of the cost.
What should I look for in a qualified cataract surgeon?
Look for an ophthalmologist who is board-certified, experienced in cataract surgery, and has a good reputation. Consider asking for referrals from your primary care physician or other healthcare professionals.
Can I have cataract surgery on both eyes at the same time?
While it is possible to have cataract surgery on both eyes, it is not typically recommended to have it done on the same day. Surgeons usually perform surgery on one eye first and then wait a few weeks before operating on the other eye to allow for proper healing and vision stabilization.
What are the potential risks and complications of cataract surgery?
Cataract surgery is generally very safe, but as with any surgery, there are potential risks and complications, including infection, bleeding, inflammation, retinal detachment, and vision loss. Discuss these risks with your surgeon.
What is the difference between a monofocal and a multifocal lens implant?
A monofocal lens corrects vision at one distance, typically far. You may still need glasses for reading or close-up work. A multifocal lens aims to provide clear vision at multiple distances, potentially reducing the need for glasses.
If I have glaucoma, can I still have cataract surgery?
Yes, you can still have cataract surgery if you have glaucoma. However, it’s important to discuss your glaucoma with your surgeon, as it may affect the surgical approach and lens selection. Sometimes, cataract surgery can even help lower eye pressure in some glaucoma patients.
Does Medicare cover YAG laser capsulotomy after cataract surgery?
Yes, Medicare does cover YAG laser capsulotomy, a procedure sometimes needed months or years after cataract surgery if the posterior capsule behind the lens implant becomes cloudy. This procedure is medically necessary to restore clear vision and is covered under Medicare Part B.