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Cataract Surgery Cost

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    Andrew Kopstein, MD

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Faced with cataract surgery, the first thing many people want to know is how much it will cost.

If you have medical insurance, the surgery will likely be covered to some extent.If not, there is still some good news. Though cataract surgery is not cheap, compared with the cost of many other surgical procedures (especially those that require a stay in a hospital), the cost of cataract surgery is relatively affordable.

In fact, cataract surgery has become a little less expensive in recent years. According to a study conducted by a leading industry analyst in 2011 (commissioned by AllAboutVision.com), if you have no health insurance and must pay for the procedure entirely on your own, you can expect to pay about $2,700 per eye (on average) for standard cataract surgery, down from $3,300 per eye in 2010.

Advanced cataract surgery with presbyopia-correcting lenses will run you an average of $4,337 per eye; this, too is less expensive than it was in 2010, when the same surgery averaged $4,461. This cost is comparable to that of laser surgery procedures to correct presbyopia, such as multifocal LASIK surgery.

Recently, laser cataract surgery has been approved for use in the United States. This procedure can also cost a bit more than standard cataract surgery. The average cost increase for laser cataract surgery is $872 per eye, according to participants at the Ophthalmology Innovators Summit.

Cataract Surgery Cost Factors

The price of your cataract surgery depends on a number of factors, including:

  • The skill, reputation and experience of your cataract surgeon
  • The area of the country and the community where your surgery is performed
  • Whether or not your pre-op exam and follow-up visits are covered in the fee
  • Whether or not your post-op medications are covered in the feeHow much of the surgery and other services are covered by private insurance or Medicare
  • Whether parts of the procedure are conducted with a laser
  • Whether you choose a standard or a premium intraocular lens (IOL)

Premium IOLs include toric IOLs that correct astigmatism and refractive IOLs that correct presbyopia to reduce your need for prescription eyeglasses or reading glasses after refractive cataract surgery.

Examples of presbyopia-correcting IOLs include accommodating IOLs, such as Crystalens, and multifocal IOLs (e.g., ReSTOR, ReZoom or Tecnis).

Medicare and Cataract Surgery Cost

Medicare pays a significant portion of cataract surgery costs for seniors age 65 or older and other eligible Americans.

Each year, the Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health & Human Services, determines the Medicare-approved costs for specific procedures and services provided by hospitals, doctors and other healthcare professionals, including those for cataract surgery.

Cataract surgery typically is an outpatient procedure (you have the surgery and go home the same day), and is therefore covered under Medicare Part B, which is designed to help cover costs associated with doctors' services and outpatient care.

In most cases, Medicare pays 80 percent of the approved cost of cataract surgery and you are responsible for the remaining 20 percent (the Medicare "copayment"), after meeting your annual deductible payment. In 2013, the annual deductible for services covered by Medicare Part B is $147.

The Medicare co-payment is made directly to your cataract surgeon. If you choose a premium intraocular lens for your cataract surgery that is not covered by Medicare (such as a presbyopia-correcting IOL), you must pay the added cost of this premium IOL to your eye surgeon as well. The same is true if you choose to have a laser cataract surgery procedure: you will have to pay the extra cost.

To reduce your cataract surgery costs, you can purchase a separate "Medigap" (Medicare supplement) insurance policy sold by private insurance companies. Medigap policies help cover Medicare co-payments and other gaps in Medicare coverage.

But be sure to read the fine print before purchasing a Medicare supplement insurance policy. These policies often have a deductible that must be met before you receive the benefit of payment of your Medicare co-payment and other costs not covered by Medicare.

Medicare also helps cover the cost of one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that includes IOL implantation. You pay 20 percent of the Medicare-approved amount, and the Part B deductible applies.

For more information about Medicare and cataract surgery cost, call 1-800-Medicare or visit www.medicare.gov.

Private Medical Insurance and Cataract Surgery Costs

Like Medicare, medical policies sold by private insurance companies typically cover only cataract surgery services and related products and services that are considered "medically necessary." The extra cost of a premium IOL typically is not covered, so you must pay the added cost of the lens out-of-pocket. Again, the same applies to laser cataract surgery; the additional cost is not covered by insurance.

Also, co-payments and deductibles often are required. Contact your plan administrator or insurance agent for details.

In many cases, private cataract surgeons have staff members who are very knowledgeable about insurance matters and can provide you with comprehensive information about your cataract surgery cost and what your insurance policy does and does not cover.

"Out-of-Pocket" Cataract Surgery Costs

Even if you have Medicare or private health or medical insurance, it is likely that you will have some out-of-pocket expenses for cataract surgery.

The amount of these costs can vary significantly, depending on your needs and the particular IOL and other products and services you choose.

For example, according to the same 2011 cost study mentioned above, the average out-of-pocket cost paid by Medicare patients with astigmatism who choose a premium toric IOL rather than a standard intraocular lens is approximately $963 per eye.

For Medicare patients who choose a presbyopia-correcting premium IOL over a standard IOL for their cataract surgery, the average out-of-pocket expense is about $1,907 per eye. For laser cataract surgery, the average additional expense is $872 per eye.

Inform Yourself Prior to Surgery

In order to fully understand the benefits and costs of premium intraocular lenses and other products and services that affect your cataract surgery cost, schedule a detailed consultation with your cataract surgeon well in advance of your surgery date.

Also, ask your eye doctor about all services and costs associated with your cataract surgery and ask your insurance provider about all copays, deductibles and other details of your coverage.

Taking these steps will help put your mind at ease and help you avoid any unpleasant financial surprises after your cataract surgery.

Follow-Up Refractive Surgery

Many people still need prescription eyeglasses or reading glasses after cataract surgery due to presbyopia and residual refractive errors.

If you want to see clearly with less dependence on glasses, it often is possible to undergo laser eye surgery — such as LASIK, PRK or LASEK — after your cataract surgery recovery is complete.

If you choose one of these follow-up refractive procedures to sharpen your vision, be aware that this involves an additional cost that typically is not covered by Medicare or private medical insurance.

Resource: Medicare & You 2010. Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services. www.medicare.gov/publications/pubs/pdf/10050.pdf.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

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