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Does Medicare Cover Cataract Surgery?

Posted on August 24, 2020

If you know that you need to have cataract surgery, one of the things that you may be thinking about is how you’ll afford the procedure. After all, if you have Medicare, you’d assume that it covers the procedure in full, but that’s not always the case.

Keep reading to learn if Medicare will cover cataract surgery in Orlando!

What Medicare covers during cataract surgery

Older woman with eyeglasses considering Cataract Surgery

If you have Medicare and need to have cataract surgery, it’s important to know exactly what your Medicare plan will cover, especially before you have cataract surgery! Here is what Medicare covers during cataract surgery:

Specifically, Medicare Part B is the part that will cover your cataract surgery, since it is your medical insurance. This only covers medically necessary healthcare services.

If it’s been determined that cataract surgery is medically necessary, your benefits under Part B include any presurgical appointments and outpatient services after surgery. You’ll pay your Part B deductible for these appointments and services.

After paying your deductible, you’ll receive your coverage from Medicare but this will not include any copayments. You’ll still need to pay for these.

If you have Medicare Advantage, you’ll get the benefits of both parts A and B. Make sure to check with your healthcare provider before your procedure to see if you’ll receive any extra coverage.

If you’re being technical, then yes, Medicare covers cataract surgery, since it covers the physical removal of the cataract. But what many people don’t realize is that there’s more to cataract surgery than removing the cataract.

Why you need to have cataract surgery

Healthy lens versus one with Cataracts

To put it simply, cataract surgery involves removing the eye’s natural lens. Before you have cataracts, the lens is clear and easy to see through.

But over time, usually as a result of aging, the lens becomes cloudy and harder to see through. When this happens, proteins in the lens start to build up and clump together in the middle of the lens.

This leads to vision impairment, blurry vision, and other frustrating symptoms of cataracts. This is why patients need their cataracts removed during cataract surgery. The only way to remove the cataract is to remove the entire lens from the eye.

Medicare covers a basic lens implant, but what is that?

The other component of cataract surgery is the removal of the natural lens and replacing it with an artificial lens. The artificial lens, known as an intraocular lens (IOL) is one of the most crucial parts of cataract surgery.

If you want to have clear vision again after cataract surgery (and you do), then an IOL is a must! Without it, you wouldn’t be able to see well and would continue being visually impaired.

Now, here’s where things can get a little tricky to understand. Medicare will only cover a basic lens implant. This is a monofocal lens.

Monofocal lenses are intraocular lenses that only have a fixed focus for one distance. This will work to allow you to see for near vision, intermediate vision, or distance vision.

With this lens, you can only see at this distance. To see at other distances, you will have to wear glasses to compensate.

Monofocal IOLs are perfectly adequate, but it’s also important to know that there are other IOL options out there. The problem? These other IOLs are what’s known as “premium lens options” meaning that Medicare will not cover their cost.

Are premium lenses worth the extra cost?

There’s no right or wrong answer here. If you don’t mind wearing glasses to see after cataract surgery, then you may have no issue with choosing a monofocal lens as your IOL.

If you want visual freedom and a life that lets you rely less on wearing glasses, a premium lens may be worth it for that reason.

What are my options when it comes to premium lens implants?

Intraocular Lens Example

If you want to consider all your options, it’s important to know what’s available to you. Herschel LASIK and Cataract Institute in Orlando offers the following premium intraocular lens options:

Toric IOLs

Toric IOLs are unique because they are the only IOL that’s specifically designed for patients with astigmatism. Astigmatism occurs when the cornea is irregularly curved.

When this happens, your vision will be distorted and blurry. It’s also common to have other refractive errors like nearsightedness and farsightedness when you have astigmatism.

Toric IOLs correct astigmatism and provide patients with clear vision after cataract surgery.

Multifocal IOLs

If the concept of needing glasses to see at more than one distance wasn’t appealing, multifocal IOLs may sound better. These IOLs restore a full range of vision in both eyes.

This includes near vision, intermediate vision, and distance vision. Multifocal IOLs work because they contain rings with different magnifications which enable a wider range of clear vision.

These rings help the brain pick the right focus automatically. This is something that patients never have to think about since it happens automatically.

There is some adjustment that may be necessary, but most patients get used to their multifocal IOLs quickly.

Aspheric IOLs

Another kind of premium lens to consider is an aspheric IOL. With aspheric IOLs, this lens is the closest to the shape of the natural lens.

Although it seems like the eye is spherical and round, it’s actual aspheric. With an aspheric IOL, patients experience a much clearer vision because the lens is much closer to the shape of the natural lens.

Aspheric IOLs also produce fewer higher-order aberrations, which can make it difficult to drive at night or be in low light situations. With an aspheric IOL, these higher-order aberrations are completely eliminated.

If you do decide to go with a premium lens implant, know that this is something that Medicare will not cover. You will need to pay for these costs out of pocket.

For many patients, the cost is worth it to finally experience visual freedom for what’s often the first time in their lives.

Have questions about cataracts or not sure if you may need cataract surgery? Schedule a cataract screening at Herschel LASIK and Cataract Institute in Orlando, FL!

Now has never been a better time if you’re ready to say goodbye to cataracts and hello to clear vision!