Cost of Cataract Surgery
Cost Of Cataract Surgery
Do you need to have a cataract removed? Are you concerned about cost of cataract surgery or wondering about health care and Medicare coverage? Before undergoing any procedure, it is important that you understand your options and obligations so that you can make an informed decision and prepare for the financial expenses.
Cataract surgery is one of the most common surgeries performed and new technologies have also made it one of the safest. However, the average cost of cataract surgery can vary depending on the severity of your cataract, the type of surgery necessary, your choice of intraocular lens (IOL), where you live, and the surgeon you choose.
Cost of Standard Cataract Surgery
Cataract is the clouding of the eye's natural lens that can interfere with and impair vision. The surgical procedure involves removing this natural lens and replacing it with an artificial lens called a intraocular lens or an IOL.
In a standard procedure, a conventional, or monofocal, lens is used. In this case, you will usually have excellent distance vision, but will likely require eyeglasses for closer activities such as reading or sewing.
In general, without health insurance, the average cost of cataract surgery with a standard or monofocal lens is about $3000 per eye. (Please note all costs quoted are in US$ and for surgeries performed in the United Sates). Most insurance companies, HMOs, and Medicare will cover this procedure.
Cost of Cataract Surgery Cost Premium Intraocular Lens
Although a monofocal lens will correct the vision problems associated with cataracts, many people choose a premium lens to help correct other pre-existing vision issues.
Premium lenses are special designed intraocular lenses that have the ability to correct refractive errors other than spherical errors such as astigmatism and presbyopia.
Toric Intraocular Lens is a premium lens that is use to correct regular corneal astigmatism while accommodating-IOLs are those used to correct presbyopia.
A multifocal IOL, or a presbyopia-correcting lens, is an option that your eye doctor will likely offer.
Presbyopia is an age related condition that diminishes your eye's ability to focus on close objects. Unlike a monofocal lens, choosing a multifocal IOL means that you will have excellent vision at varying distances - near, intermediate, and far. This reduces the likelihood that you will need eyeglasses.
Medicare and most insurance companies base their coverage and reimbursement policies on what they refer to as "medically necessary" procedures.
They will usually pay to have the cataract removed and a conventional lens inserted; however, they consider the insertion of presbyopia-correcting IOLs to be an elective procedure so you will likely be responsible for any additional costs associated with premium lenses.
Since premium lenses are optional and not a necessary part of cataract removal, there are no set fees and the cost can vary from doctor to doctor. On average, the additional cost is about $1900 per eye, making the final average cost of cataract surgery around $4500 per eye.
Cost of Cataract Surgery with Astigmatism Correction
If applicable, your doctor may also offer an extra surgical procedure to correct astigmatism. Even with the removal of your cataract and the choice of a premium Intraocular lens, your vision could still lack crispness and clarity due to astigmatism.
In this case, your surgeon may recommend limbal relaxing incisions (LRIs) or corneal relaxing incisions (CRIs). Basically, these are small, superficial cuts made to flatten the cornea and reduce or eliminate astigmatism.
Again, since this is not considered a medically necessary procedure, the extra expense would be your responsibility. The average cost for astigmatism correcting surgery is about $528 per eye.
Also, if you do not need presbyopia-correcting lenses, you may be given the option of choosing premium astigmatism-correcting lenses called toric intraocular lens. These are "fixed" lenses which help correct astigmatism related vision problems caused by an irregularly shaped cornea.
Although less expensive than presbyopia-correcting lenses,toric Intraocular lenses are an average of $950 extra per eye.
In summary, without insurance, the average cost for cataract surgery is $3000 per eye. If you choose a multifocal or toric lens, or request an astigmatism correcting procedure, the cataract surgery cost can increase to a total of $4000 - $5500 or more per eye.
Medicare and Health Insurance for Cataract Surgery
Medicare and most health insurance providers can cover cataract surgery cost with a conventional monofocal Intraocular Lens, but will not reimburse additional expenses for premium lenses or astigmatism correcting procedures. You may be responsible for any cost differences.
In addition, you may also be required to pay related costs such as eye exams and measurements, anesthesiologist or anesthetist expenses, eyeglasses, and any necessary treatments due to complications that are not included in the typical 90 day post-operative period.
With private health insurance providers, your cost could vary depending on your deductible, the rate of copay, the terms of your policy, and whether your agreement includes full or partial coverage of eyeglasses.
It is important that you ask your surgeon for an exact breakdown of the cataract surgery cost and then talk to your insurance provider or Medicare representative so that you know precisely what they will cover and what your out-of-pocket expenses will be.