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does medicare cover cataract surgery in florida

Does Medicare cover cataract surgery?

If you’re struggling to understand Medicare, Connie can help. Ask Connie your question, and a local, licensed agent will help you navigate your Medicare journey. Complete this form to have your question answered. It could be featured on Dear Connie.


Dear Connie,

I’ve used glasses for nearly my entire life, but recently I’ve found my vision deteriorating. My vision is blurry, hazy, and less colorful. I am also having more trouble reading.

I’ve done some research online, and I think I may have developed cataracts. I’m wondering, does Medicare cover cataract surgery in Florida?

Worried about my vision,
Sharon from Fort Lauderdale, Florida

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Dear Sharon,

We’re happy that you’ve reached out to us with your question.

Cataracts are very common. In fact, 50% of people 80 or older have cataracts or cataract surgery.

Because most cataracts are age-related, it’s most likely because of expected changes in your eyes. In some cases, they can also develop after an eye injury or glaucoma, but you didn’t mention those. As you may have researched, the only treatment for cataracts is surgery.

You may have cataracts if your vision is blurry, hazy and colors are less vibrant. However, the only way to know is if you see your eye doctor to check. Your ophthalmologist will perform a simple and painless dilated eye exam to check for cataracts and other eye problems.

While your symptoms might be mild at first, as cataracts grow – and they do – they can cause more severe changes to your vision. These changes could include:

  • Cloudy or blurry vision
  • Faded or less vibrant colors
  • Difficulty seeing well at night
  • Lamps, sunlight, or headlights appear too bright
  • You may see halos around lights
  • You see double
  • You need to change your prescription eyeglasses or contact lenses frequently.

Of most importance. If you don’t have your eyes checked and have cataracts or another eye problem, you risk vision loss. So, we’re really happy you’re being proactive and asking questions.

Agent tip:

“Original Medicare may cover 80% of a traditional cataract surgery. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.“

Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. You must pay 20% of the procedure plus the Part B deductible and medications. However, more advanced treatments, like laser and New Technology Intraocular Lenses (NTIOLS), may require that you cover a more significant percentage or even all of the cost.

Original Medicare may not cover multifocal or toric lenses, but it will cover mono-focal lenses. You should check with your ophthalmologist and doctor to discover their recommended procedure.

Suppose you’re worried about the out-of-pocket costs for your vision exam and potential cataract surgery. In that case, you should research and enroll in a Medicare Supplement (Medigap) or Medicare Advantage plan in Florida.

A Medigap plan can help you cover the out-of-pocket expenses for the 20% cost of the cataract surgery, while Medicare covers 80%.

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Suppose you’re looking for a Medicare plan that will cover the entire cost of the cataract surgery, plus coverage for the vision care appointments to discover what’s ailing your eyes. In that case, a Medicare Advantage plan might be best for you.

A Medicare Advantage plan is available at a $0 monthly premium and often comes with vision, dental, hearing, and other extra benefits that you can’t get with Original Medicare or a Medigap plan. If you have vision coverage, this might be the most cost-effective option.

I hope this information helps you discover your next steps. You’ll definitely want to see an eye doctor. And if you’d like your exam and eyeglasses covered, we can help you choose a Medicare Advantage plan with those benefits. If vision coverage isn’t essential, we can help you select a plan that accepts Medicare at your preferred cataract surgery center.

At Connie Health, we help you throughout your Medicare journey. For additional coverage questions, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711) for help.

Sources

Cataracts.

Last updated: February 24, 2023

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Frequently Asked Questions

What does Medicare cover for cataract surgery?
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Original Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. You must pay 20% of the procedure plus the Part B deductible and medications. However, more advanced treatments, like laser and New Technology Intraocular Lenses (NTIOLS), may require that you cover a more significant percentage or even all of the cost.

Original Medicare may not cover multifocal or toric lenses, but it will cover mono-focal lenses. You should check with your ophthalmologist and doctor to discover their recommended procedure.

Suppose you’re worried about the out-of-pocket costs for your vision exam and potential cataract surgery. In that case, you should research and enroll in a Medicare Supplement (Medigap) or Medicare Advantage plan.

A Medigap plan can help you cover the out-of-pocket expenses for the 20% cost of the cataract surgery, while Medicare covers 80%.

What type of lens does Medicare cover for cataract surgery?
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Original Medicare may not cover multifocal or toric lenses, but it will cover mono-focal lenses. You should check with your ophthalmologist and doctor to discover their recommended procedure.

Mono-focal lenses and traditional cataract surgery are covered 80% by Original Medicare through Medicare Part B. You would be responsible for the remaining 20% of the procedure, plus the Part B deductible and medications.

Does Medicare cover laser cataract surgery?
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Original Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. You must pay 20% of the procedure plus the Part B deductible and medications. More advanced treatments, like laser and New Technology Intraocular Lenses (NTIOLS), may require that you cover a more significant percentage or even all of the cost.

Does Medicare pay for glasses after cataract surgery?
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Original Medicare Part B helps pay for corrective lenses if you have cataract surgery that implants an intraocular lens. You can get one pair of eyeglasses with standard frames OR one set of contact lenses, but not both.

After you meet the Medicare Part B deductible, you pay 20% of the Medicare-approved amount for corrective lenses. If you want an upgraded frame, you would pay all additional costs. Also, Medicare will only pay for contact lenses or glasses from a Medicare-enrolled supplier, no matter if you or your supplier submits a claim. So, check whether your corrective lens supplier is Medicare enrolled, or you could pay entirely out-of-pocket.

Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage plus cataract surgery without out-of-pocket coinsurance costs.

How much does cataract surgery cost with Medicare?
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The cost of cataract surgery depends on where it occurs. Original Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. You must pay 20% of the procedure plus the Part B deductible and medications.

According to Medicare.gov, at an ambulatory surgical center, the national average cost is $1,808, of which Medicare will pay $1,445, while you would pay $361. The national average cost of a hospital outpatient department is $2,866, which Medicare will pay $2,292. You would pay the remaining 20%, which would cost $573.

These national averages include facility and doctor fees. You may need more than one doctor, and additional costs may apply.

Alternatively, a Medicare Advantage plan often provides cataract surgery without out-of-pocket coinsurance costs.

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Read more by William Revuelta

I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.

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