Pricing cataract surgery can feel like buying a car. There are countless options. You can select a “basic” cataract surgery with a monofocal lens, a “deluxe” procedure with all the bells and whistles of a premium lens, or somewhere in between. Of course, the cost increases according to the number of add-ons and elective options you choose, but it may not be as expensive as you think.
Single Focus IOL (Basic Cataract Surgery)
Most people who need cataract surgery qualify for Medicare or private health insurance which will cover the cost of the removal of the deteriorated lens and the insertion of a monofocal intraocular lens (IOL). A monofocal IOL allows clear distance vision, near vision or intermediate vision, but not all three. Most people choose an IOL to correct distance vision, but they will still need to wear glasses to correct near vision and/or astigmatism.
Astigmatism-Correcting, Multifocal or Accommodating IOL
If you would like an advanced IOL that allows you to see clearly at multiple distances or corrects astigmatism, you should expect an out-of-pocket expense. However, you will not be responsible for the entire procedure. For example, Medicare does not cover astigmatism-correcting IOLs because astigmatism can be corrected with glasses. Medicare and private insurance will cover the medically necessary portion (Basic Cataract Surgery), but you will have to pay the difference for the premium lens. You will also be financially responsible for the Refractive Portion (Advanced or Premium) such as screening tests, refractions, presbyopic correction, LASIK, or extended postoperative care.
Let’s Talk Numbers
In 2015, the average, basic cataract surgery in the United States cost about $3,542 per eye. This amount would be covered under Medicare or private health insurance. If you choose to have an advanced technology lens that corrects astigmatism or presbyopia, you could expect to pay anywhere from $900 to $5,000 per eye. When considering the years of enjoyment you will receive from a premium lens, you may decide that it is a worthwhile investment (Source: All About Vision).
Two Important Phone Calls
If you are considering cataract surgery, call your eye care professional to make an appointment for a comprehensive eye exam to talk through your options. Then, call your insurance provider and ask:
- Is cataract surgery covered or medically necessary?
- Is astigmatism or presbyopia correction covered?
- Is Refractive or Refraction technology covered? Are screening tests covered?
- How much is the copay at the surgery center?
- How much is the copay for the surgeon?
- How much does insurance cover the Advanced Cataract Surgery portion for the surgery center?
- How much does insurance cover the Advanced Cataract Surgery portion for the surgeon?
- How much deductible do I need to meet?
- Is the cataract surgeon a preferred provider?