If you have cataracts, the cost of cataract surgery should not be a barrier to the care that you need to regain useful vision. In almost all instances, cataract surgery costs are considered reimbursable expenses under both Medicare and private insurance plans. If you are considering cataract surgery you should become familiar with: how much you might need to pay out of pocket, what deductibles might apply, what co-pays might apply and what services might not be covered or require additional payment. For the vast majority of people, their insurance by itself or in conjunction with Medicare is going to cover the bulk of the cost of cataract surgery.
Private Insurance and Cataract Surgery Costs
In most instances private insurances covers a portion, if not all, of the cataract surgeon’s fee, the surgery facility fee, the cost of a Monofocal Lens Implant and the necessary follow up care after your surgery. Private insurances vary in the deductible that you may required to pay, the co-pay you might be responsible for and the percentage of each allowable expense that they might reimburse. Please remember: the deductibles, the percentage coverage and any co-pays are individual to your specific insurance plan.
When you visit Eye Center of Texas a member of our staff will review the details of your insurance coverage and let you know what your coverage is and what out of pocket expenses, if any, will be required of you. It is likely that you will responsible for a co-pay or a deductible for your evaluation, but this depends on your insurance plan.
One item to be aware of is that insurance companies only cover the use of a traditional Monofocal Lens Implant to correct vision after cataract surgery and most if not all require that you individually pay for the cost of Astigmatism Correcting Toric Lens Implants, Multifocal Lens Implants and the use of the LenSx Laser technology. Any additional fees will be reviewed with you by the staff and convenient arrangements for payment will be made.
Medicare and Cataract Surgery Costs
Medicare for cataract surgery is also quite comprehensive. Medicare covers a portion, in not all, of the cataract surgeon fee, the surgery facility fee, the cost of a Monofocal Lens Implant and the necessary follow up care after your surgery. It is likely that you will responsible for a co-pay or a deductible for the initial evaluation.
Medicare will pay 80% of the “Medicare Allowed” charges for your Cataract Surgery. Medicare determines what is “allowed” and the cataract surgeon agrees to this determination. Under Medicare coverage it is likely that you will be responsible for the 20% difference remaining between the fee collected by surgeon from Medicare and the actual “Medicare Allowed” charges. Many Medicare beneficiaries also have secondary insurance to cover their “20%” of the Medicare Allowable charges. If you do please make sure to bring this to the attention of our staff.
Medicare will cover the cost of a basic Monofocal Lens Implant. Medicare requires that you pay individually (aka…out of pocket) for the cost of Astigmatism Correcting Toric Lens Implants, Multifocal Lens Implants and for the use of the LenSx Laser technology. Any additional fees will be reviewed with you by the staff and convenient arrangements for payment will be made.
Please note: advanced technology lens implants will require additional testing that are not covered by Medicare or private insurance. The cost is $95.00 per eye and are strongly recommend by our cataract surgeons, Dr. Mark L. Mayo and Dr. Edward C. Wade.