Whether you recently learned that you have cataracts and want to prepare or are getting ready for cataract surgery, understanding your out-of-pocket costs is essential. The most common question for those with insurance is whether their policy covers cataract surgery. If you’d like to learn more about whether health insurance handles any of the costs of cataract surgery, here’s what you need to know.
Does Private Health Insurance Cover Cataract Surgery?
Generally, major private health insurance policies do cover cataract surgery. However, how much of the related expenses they’ll cover can vary as each insurer sets its own limits, percentages, and rates.
Additionally, private health insurance usually covers traditional monofocal lens implants. If you’re considering premium cataract lenses, such as multifocal intraocular lenses (IOLs) or Toric IOLs, your health insurance provider may not cover the upgraded lenses.
Does Medicare Cover Cataract Surgery?
As with major private health insurance policies, Medicare does cover cataract surgery for qualifying individuals. Generally, the same limitations also apply, like the coverage being limited to traditional monofocal lens implants.
What Kind of Cataract Surgery Is Covered by Insurance?
As mentioned above, most insurance companies cover cataract surgery using traditional monofocal lens implants. This includes the cost of the lenses themselves, as well as any facility or physician services related to the surgery, suggesting that the providers are part of the insurer’s network or are eligible for coverage as an out-of-network provider.
If you opt for premium IOLs, the policies won’t typically cover the cost of those lenses. However, the coverage may handle the physician or facility costs based on the policy’s percentage, though that can vary from one provider to the next.
Are There Out-of-Pocket Expenses with Cataract Surgery?
Out-of-pocket expenses are common for cataract surgery. Most policies only cover a percentage of the associated costs. For example, Medicare Original covers 80 percent of the related expenses, so the patient is responsible for the remaining 20 percent if they don’t have supplemental insurance to handle the rest.
If a patient opts for premium IOLs over traditional monofocal lens implants, they’re typically responsible for the full cost of the premium IOLs. At times, the insurance may not handle other related expenses since it involves another lens type, though this isn’t always the case.
How to Cover Out-of-Pocket Expenses
If you need cataract surgery, you have several options for handling any out-of-pocket expenses. While the most straightforward is paying cash, that isn’t the only viable approach. Supplemental insurance may address the out-of-pocket costs. You can also tap flexible or health savings accounts. Finally, there are financing options through companies like Care Credit, which can work well if you don’t have another source of funds available.
The Best Cataract Surgeons In WNY
At ECVA, the safety and health of our patients’ eyes are our priority. If you’re considering cataract surgery and would like to work with an eye care provider to see if it’s right for you or simply haven’t seen your eye care provider in the past year, the ECVA team is here to help. Schedule an appointment at your closest ECVA clinic today.
