💡 Does Medicare Cover Cataract Surgery?

Cataracts are one of the leading causes of vision impairment, but there is no reason to suffer with them. If you are eligible for coverage, Medicare will cover medically necessary procedures like cataract surgery based on the health plan and other insurance coverage you may have.

There are several different types of Medicare plans, including Original Medicare, Medicare Advantage Plans (like an HMO or PPO), and others. Although they have many benefits in common, the rules vary by plan and some coverage will depend on where you live. It’s important to contact your plan directly for answers to your questions.

Medicare will cover only the cost of conventional monofocal intraocular lenses (lenses that are not presbyopia or astigmatism-correcting). These conventional lenses will give you good distance vision, such as for when you’re driving. For near or intermediate vision, such as reading or using the Internet, most people with monofocal lenses will need to wear glasses after cataract surgery.

If you are eligible for Medicare coverage, Medicare will pay for the following expenses:

  • Eye exams to evaluate you for signs and symptoms of eye disease; and
  • Doctor and facility services and supplies that are required to insert a conventional intraocular lens (IOL) during cataract surgery; and
  • The cost of the conventional IOL implanted during cataract surgery; and
  • One pair of eyeglasses (with basic frames) or contact lenses after each cataract surgery involving the insertion of an IOL (and only from a supplier enrolled in Medicare).
  • Prescription medications required after cataract surgery, such as special eye drops, are usually partially covered by Medicare Part D.

Most of the expenses listed above are covered under Medicare Part B. You will typically be responsible to pay a 20% coinsurance for the surgery plus your Medicare deductible, and will be required to pay for any expenses not covered by Medicare.

Many Medicare subscribers purchase a supplemental insurance policy to cover the 20% coinsurance, deductible, and their other out-of-pocket expenses. Some patients are also covered by a spouse’s employer-sponsored health plan. If you have these types of coverage in addition to Medicare, please be sure to bring it to the attention of our staff upon arrival.

If you and your doctor decide that a different type of IOL may work better for you, such as a multifocal lens (presbyopia-correcting) or a toric lens (astigmatism-correcting), Medicare will not make payment for services that are specific to the insertion, adjustment, or other subsequent treatments related to these other lenses. For example, Medicare does not cover the rotation of a toric IOL to properly align the axis. You will be required to pay the difference in cost between these lenses and conventional lenses out of your pocket or through a supplemental insurance plan.

If you are covered by a Medicare Advantage Plan, you will likely be covered for eyeglass frames and one pair of eyeglass lenses or contact lenses every 24 months.

Importantly, since Medicare and other health insurance rules are constantly changing, it is very important that you check with your insurance provider for the latest inclusions and exclusions regarding your plan.

✳️ Corneal Transplants

When an injury or disease damages your cornea, a corneal transplant may be able to restore or dramatically improve your vision. A corneal transplant is an outpatient procedure. Most corneal transplants have a favorable outcome, and success rates are rising as techniques and training methods improve.

The cornea is the clear covering of the front of the eye which bends (refracts) light rays as they enter the eye. For clear vision to occur, the cornea must have the correct shape and power to focus incoming light rays precisely on the retina at the back of the eye. When the cornea loses its transparency, whether from injury, infection or disease, transplantation may be recommended to replace it.

Your corneal tissue can quickly heal minor injuries and scratches before you experience infection or visual disturbances. However, deep injuries can permanently damage your vision. A corneal transplant, or keratoplasty, is a surgical procedure that replaces a damaged or diseased cornea with healthy tissue from a donor.

The corneal tissue comes from a recently deceased, registered tissue donor. Because almost everyone can donate their corneas after they die, the waiting list is usually not as long as for other major organ transplants. The tissue generally comes from an eye bank and will undergo testing before transplantation to make sure it’s safe for you.

If you aren’t a good candidate for transplantation with donor tissue, you may be a candidate for an artificial cornea transplant. Donor tissue tends to bring about the best results for the majority of people. However, an artificial transplant may be more successful for people who either have severe ocular surface disease or have had more than one failed graft in the past.

✳️ Proud to Offer ORA Aberrometry

Eye Surgery Center of San Francisco is proud to offer ORA Aberrometry (ORA) to our patients. ORA helps improve cataract surgery outcomes by providing an intra-operative precision guidance system for the surgeon through the operating microscope. The ORA improves the alignment of toric implants for the correction of astigmatism, with the precision of Limbal Relaxing Incisions (LRIs) for the improvement of astigmatism and for more accurate implant power selection especially in patients who have had previous LASIK.

Please ask one of our doctors about the enhanced technology of ORA (Optiwave Refractive Analysis) System with VerifEye+ by Alcon if you are considering cataract surgery. Improved surgical outcomes may help you be less dependent on glasses.

Eye Surgery Center of San Francisco is a center of excellence for cataract surgery with advanced technology implants, featuring outstanding services offered by recognized doctors. Please contact one of our eye-care practitioners to schedule your consultation for possible treatments for your eye condition.

✳️ MicroPulse Laser Therapy

At the Eye Surgery Center of San Francisco, we offer MicroPulse Laser Therapy to safely and effectively treat patients with retinal disorders and open-angle glaucoma. MicroPulse works by electronically “chopping” the continuous-wave laser emission used in conventional laser treatment, into trains of tiny, repetitive, low energy pulses separated by a brief rest period in between. This “micropulsing” allows the tissue to cool between laser pulses, preventing damage. MicroPulse laser therapy also can be used in conjunction with drug therapy, allowing complete and optimized management of retinal diseases and glaucoma without laser-induced damage.

Benefits of MicroPulse Laser Therapy

  • Increased visual success compared to conventional laser treatment
  • Physician can more precisely control the laser on targeted tissues
  • Less chance of tissue burns and scarring than conventional laser treatment
  • Increased patient comfort and satisfaction
  • Outpatient procedure
  • Painless, requiring only anesthetic eye drops
  • Can be repeated as necessary without harm to the patient’s vision

Ask one of our doctors if you are a candidate for this revolutionary procedure.

ℹ️ 10 Statistics on Eye Health in United States

Throughout the United States, more than 24.2 percent of Americans over 40 have cataracts, according to American Academy of Ophthalmology.

Here are nine more statistics:

  1. Almost 50 percent of U.S. residents over 75 have cataracts.
  2. Of Americans ages 40 and over, more than 2.7 million residents have glaucoma.
  3. Surgeons performed 48,229 corneal implants in the United States in 2013.
  4. Since 1961, surgeons have restored more than 1 million patients’ vision through a corneal implant.
  5. Almost 1.3 million Americans 40 and older are legally blind.
  6. Annually, there are nearly 2.4 million eye injuries in the United States.
  7. In 2010, surgeons performed nearly 800,000 refractive surgical procedures.
  8. In 2014, there were 19,216 active ophthalmologists in the United States.
  9. Worldwide, there were nearly 213,459 ophthalmologists in 2014.

Source: Becker’s ASC Review