Medicare can help with cataracts

By Greg Dill

Cataracts often come with age and can affect your vision. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. New eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses may help your symptoms. If not, you may need surgery.

If you have cataracts and need cataract surgery, Medicare can help. And after surgery, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses you get from an ophthalmologist.

Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses (one pair of eyeglasses with standard frames or one set of contact lenses).

Greg Dill

Medicare covers the surgery if it’s done using traditional surgical techniques or using lasers.

Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare. This is true no matter who submits the claim (you or your supplier).

What will you pay if you have Original Medicare?

  • You pay 20 percent of the Medicare-approved amount for one pair of eyeglasses or one set of contact lenses after each cataract surgery with an intraocular lens.
  • You pay any additional costs for upgraded frames.
  • The Part B deductible ($183 in 2018) applies.

How much will you pay for the surgery with Original Medicare?

With surgeries or procedures, it’s hard to know the exact costs in advance. This is because no one knows exactly what services you’ll need. If you need surgery or a procedure, you may be able to estimate how much you’ll have to pay. You can:

  1. Ask the doctor, hospital, or facility how much you’ll have to pay for the surgery and any care afterward.
  2. Find out if you’re an inpatient or an outpatient, because what you pay may be different in each case.
  3. Check with any other insurance you may have to see what it will pay. If you belong to a Medicare Advantage or other Medicare health plan, contact your plan for more information. Other insurance might include: Medicare Supplement Insurance (Medigap); Medicaid; or coverage from your or your spouse’s employer.
  4. Log in to, or look at your last “Medicare Summary Notice” to see if you’ve met your deductibles.
  • Check your Part A deductible if you expect to be admitted to the hospital.
  • Check your Part B deductible for a doctor’s visit and other outpatient care.
  • You’ll need to pay the deductible amounts before Medicare will start to pay. After Medicare starts to pay, you may have copayments for the care you get.

What is a cataract and what causes it?

A cataract is a clouding of the lens in the eye that affects vision. The lens lies behind the iris and the pupil. It works much like a camera lens, focusing light onto the retina at the back of the eye, where an image is recorded.

The lens also adjusts the eye’s focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and allows light to pass through it.

As we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or it may be that the protein in the lens just changes from wear and tear over the years.

A cataract can occur in either or both eyes, but it can’t spread from one eye to the other.

Greg Dill is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

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