Utah Eye Associates

Cataract Surgery and Medicare Coverage

By Dr. David Masihdas on June 03, 2019

Stages of cataract surgeryCataracts form when proteins clump together on the clear lens of the eye, creating a cloudy buildup that interferes with vision. In their early stages, medication and glasses allow patients to maintain their vision. However, cataracts are a progressive condition that will eventually require surgical treatment.

Cataracts can develop at any age, but in most cases, it is an age-related condition. Since senior patients are likely to have Medicare insurance coverage, it is normal to question how cataract surgery and Medicare coverage works.

At Utah Eye Associates in Salt Lake City, UT, Dr. David Masihdas discusses what type of coverage patients can expect when they undergo cataract surgery.

Is Cataract Surgery Covered by Medicare?

Many patients are happy to hear that cataract surgery is covered by Medicare insurance. The only requirement is that cataract surgery must be deemed medically necessary by the patient’s doctor. If cataracts are being effectively controlled through other treatment methods, Medicare may not approve cataract surgery.

Once a doctor determines that cataract surgery is the only way to preserve a patient’s vision, insurance coverage should be approved without any problems.

What Parts of Treatment Will Be Covered?

Medicare should provide insurance coverage for any part of the cataract surgery procedure that is deemed medically necessary. This includes the pre-surgery exam, the surgical procedures itself, and any necessary follow-up exams and treatment.

Even though Medicare does not typically provide vision coverage, it will cover the cost of prescription eye care as part of cataract surgery. Most often, cataract surgery involves the placement of an intraocular lens, which is essentially a permanent contact lens. In some cases, a clear lens is placed and the patient relies on glasses or contact lenses to further treat vision after cataract surgery.

In any case, our Salt Lake City patients will require some type of vision care to maintain clear eyesight after cataract surgery. Medicare will cover the expense of eyeglasses, contact lenses, or intraocular lenses for cataract surgery, depending on the details of each treatment.

Can I Expect Out-of-pocket Expenses?

Although Medicare does provide coverage for cataract surgery, patients may incur some out-of-pocket expenses. Unless a patient has supplemental insurance, he or she will be responsible for paying any coinsurance fees or deductibles that are part of their Medicare plan.

Patients will also be responsible for covering the cost of any extra expenses, or those that are not deemed medically necessary. For instance, the cost of basic IOLs will be covered by Medicare, but many of our Salt Lake City patients opt to have premium IOLs placed during their procedure.

Premium IOLs provide a better range of vision and work more like the natural eye. Medicare will cover the cost of placing a monofocal IOL, but patients will need to cover the additional cost of a premium lens.

Contact Us

If you need cataract surgery and have questions about Medicare coverage or the cost of treatment, the team at Utah Eye Associates would be happy to help. Contact us at your earliest convenience, or schedule a personal consultation with Dr. David Masihdas by calling (801) 363-2851.

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Salt Lake City Office

150 S 1000 E
Ste 100
Salt Lake City, UT 84102

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