Focus on Eyes: Medicare may or may not cover cataract surgery. Here's a breakdown of why
Q: How does Medicare cover for cataract surgery?
A: Cataract occurs when the natural lens inside the eye becomes cloudy.
Most cataracts are associated with aging.
Other causes of cataracts include trauma, side effects of medication and congenital conditions.
Cataract surgery is the only treatment for cataracts. It involves the removal of the cloudy lens and insertion of an artificial lens implant.
Original Medicare covers cataract surgery through Medicare Part B when the surgery is considered medically necessary.
For it to be a medical necessity, it must cause functional impairment and visual disability.
Dr. Ho's previous columns:
Bet you didn't know...: Did you know sleep apnea can affect your eyes? Well, it can
Eye care: Your eyes need as much sun protection as your skin
Bet you didn't know this: The eyes can often show signs of a sexually transmitted disease
Functional impairment means lost or decreased ability to perform everyday activities.
They may be leisure activities such as following a golf ball or daily activities such as seeing road signs clearly.
Visual disability means seeing less than 20/40 in an eye chart.
In some people, although they can read 20/40 or better in the eye chart, they may have difficulty functioning due to glare or double vision in one eye.
There may be a marked difference in the prescriptions of the eyes that interfere with binocular vision.
Some people may need better than 20/40 to obtain the necessary occupational licenses.
Medicare also covers cataract surgery for lens-induced diseases such as certain kinds of glaucoma and inflammation inside the eye.
When the surgery is qualified for Medicare coverage, Medicare will pay 80% of the allowable amount, including doctor visit, pre-surgery testing, post-surgery care, surgical facility fees and anesthesia during surgery.
The patient will be responsible for the annual Medicare Part B deductible and the 20% coinsurance of the allowable amount.
Medigap or Medicare Secondary plans can cover some costs related to cataract surgery such as coinsurance and deductibles.
Eye drops and medications that are required for the healing with cataract surgery are covered by Medicare Part D.
Medicare may also pay for 80% of the glasses with standard frames and lenses after cataract surgery from optical shops that accept Medicare assignment. This is the only situation where Medicare pays for eyeglasses.
Medicare does not cover the additional cost associated with laser cataract surgery, which uses a laser to fragment the cataract or make incisions to correct astigmatism.
Medicare will pay for lens implants with one focus distance. Advanced technology lens implants that correct astigmatism or provide bifocal vision are not covered by Medicare.
In addition to the Original Medicare, there are now many Medicare Advantage plans.
Original Medicare allows cataract surgery to be performed by any ophthalmologist that accepts Medicare.
Medicare Advantage plans typically require surgery through the in-network ophthalmologists and surgical facilities.
Some Medicare Advantage plans have patient copay for the surgeon and surgery center. Unlike Traditional Medicare, different Medicare Advantage plans have different coverage, it is best to check on the coverage prior to scheduling of surgery.
Dr. Frederick Ho, the medical director of Atlantic Eye MD and Atlantic Surgery and Laser Center, is a board certified ophthalmologist. Atlantic Eye MD is located at 8040 N. Wickham Road in Melbourne. To make an appointment please call (321) 757-7272. To learn more visit AtlanticEyeMD.com.
This article originally appeared on Florida Today: Does Medicare cover cataract surgery? Here's what you need to know
