The federally funded insurance health program Medicare is one of the most comprehensive, and presently offers coverage to around 18 percent of the total US population. Accounting for 58 million people, Medicare is a boon to beneficiaries, opening up access to the most advanced medical regimens. By virtue of covering two specific categories of citizens – aged 65 and above, younger patients with specific disabilities – it is important to understand if all age related conditions are covered under the program. One of the most frequently asked questions in various forums is – does medicare cover cataract surgery? Let’s take an informed look at the program to understand the facts and set the record straight.
What are the different parts/plans of Medicare and does medicare cover cataract surgery?
Medicare is offered under different plans or parts, which covers specific services to beneficiaries. The four different Parts of Medicare are as given below, which will help answer the question – does medicare cover cataract surgery?
Part A – referred to as Hospital Insurance Part, this covers the beneficiary’s inpatient hospital costs, part of home care costs, expenses towards care in a hospice, or costs towards care in a accredited nursing facility.
Part B – known as Medical Insurance, this covers costs towards medical supplies, expenses incurred in outpatient care, costs towards certain professional services of doctors or expenses incurred as part of preventive care.
Part C – commonly known as Medcare Advantage, this is a comprehensive program that offers all the other parts in a single bundled offering. In other words, a beneficiary is covered under Part A, Part B, and Part D under Medcare Advantage.
Part D – commonly identified as Prescription Drug Cover, this takes care of costs towards prescription medication, in addition to Cost Plans, Savings Account Plans, Private Fee for Service Plans and Original Plans of Medicare.
What is cataract and surgery and which Part of Medicare applies to the procedure?
The possibility of aged individuals having to undergo cataract surgery is relatively high due to the onset of the condition with age. Cataract causes the clouding of the lenses, which progressively impacts vision in individuals. Cataract surgery involves the removal of the natural lens, and in most cases involves replacement with artificial lens. The surgery is performed on an outpatient basis, which precludes the need for hospitalization as an inpatient. The procedure is relatively safe, takes less time and is performed by a certified ophthalmologist.
Now that we have taken a good look at the surgery from a category point of view, lets use this information to answer the question – does medicare cover cataract surgery?
A simple check of the Plans indicates that Medicare does not cover screening tests for the eye. However, Medicare covers a portion of the expenses incurred in cataract surgery. The extent of cover depends on the Plans and the type of surgery involved. There are two types of procedures involved in the surgery – phacoemulsification and extracapsular.
Does medicare cover cataract surgery in parts, and which costs are covered?
Typically, Medicare covers costs towards the removal of the cataract, the expenses incurred in implanting the lens and the costs towards vision enhancement through eyeglasses/contact lens. The different parts of Medicare – Part A, B, C and D cover a specific part of the procedure and the associated costs. The expenses incurred in cataract surgery will be covered by various parts of the Medicare Plan. However, this will still leave out certain expenses which have to be borne by the patient. To a certain extent, a supplement plan, commonly known as Medigap Plan will help to cover costs. It is important to note that even with a Medigap Plan, it may not be always possible to get coverage for all expenses.
Steps to ensure that costs towards cataract surgery are covered by Medicare
The information furnished above conclusively answers the question does medicare cover cataract surgery in the affirmative. However, it is important to check if the manner in which the procedure is performed makes it applicable for cover under Medicare, failing which you are likely to end up paying for the procedure from your pocket. Check if the procedure will require you to be registered as an inpatient or outpatient. Depending on where the surgery is performed, different Parts of Medicare will apply. Therefore, it is necessary to check if the surgery will be performed at a hospital or at any accredited surgical clinic. Ensure that the center/hospital that will conduct the surgery accepts Medicare. Check out the prescription medications that may be required after the procedure, and cross-check if this figures in Medicare Part-D.
Bear in mind that costs are variable and differ from person to person despite being in the same category. For instance, the type of surgery, the actual duration of the procedure, and the place where the procedure is performed will determine the overall costs of the procedure.
To sum up, Medicare covers cataract surgery costs. However, the extent of cover depends on various factors which can be easily determined before the actual procedure.