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Is Cataract Surgery Covered By Medicare?

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Medicare is the medical health insurance for people who are above the age of 65, on disability for more than 2 years, or in end-stage renal failure. It is a way for people to get health insurance provided by the government for a low cost. There are some premiums involved, but typically it is a lot less expensive than paying out of your own pocket for medical procedures. Before Medicare came into play, it is estimated that 40% of elderly people could not afford the medical care they need. Do you need to know if Medicare covers cataract surgery? Then keep reading.

What Are Cataracts?

Cataracts are a medical condition involving your eye. What happens is a milky cloud starts to form in the eye. It’s a progressive condition and it is totally painless, but it does start to block the vision which is why it is problematic. Usually people get them as they age, and if they are not taken care of, can cause blindness. However, most people get them fixed before that with cataract surgery, and they deal with the cloudy or foggy vision for a time before that. The blurriness is different than when you have poor vision, it is a distinctly milky cloudy view that lets you know this is what you have. You may also develop a problem seeing in bright light, or at night, due to bright headlights. You may have double vision, problems seeing certain colors or an improved ability to see close up in the early stages.

No one knows the exact cause of cataracts, but they do know that certain things can make you more likely to get them: Diabetes, smoking, drinking alcohol, injury to the eye, medical treatment with corticosteroids, or a lot of sun exposure to the eye. To diagnose cataracts a doctor will look into your eye when it is dilated to see what is going on inside.

What is Cataract Surgery

During a cataract surgery, the surgeon will take out the cloudy and milky lens and replace it with a new one. The good news is that this is usually a simple and successful outpatient procedure. Before this type of surgery was available you would just go blind and have to deal with it. Some form of cataract surgery has existed since Ancient times, but the older surgeries were definitely more gruesome. People in Ancient Egypt would use a lancet to break the cloudy parts up into pieces and push it back into the eye so the body would absorb it. This procedure is known as couching.

Starting in 1748, cataract extractions were done, but it wasn’t until about 60 years ago that people really were able to replace the lens with a new one. Staring in 1949, research began, with a few unsuccessful attempts before success, to replace the lens. Now the surgery is commonplace and has a 98% success rate! When the current accessible iteration of the surgery came to be in the 80s, people who had been blind for 30 years were able to finally see again through a simple surgery.

Like any surgery, cataract surgery does have some minor risks, although as previously noted, there is a high success rate for the surgeries. You could lose your vision totally, end up with permanent double vision, get an infection or experience inflammation. However, these symptoms are rare. Even though 98% of the surgeries are a success, only 90% of people see truly improved vision afterwards, but that is still a statistic that makes it worth it!

Does Medicare Cover Cataract Surgery?

There is good news for people on Medicare who are suffering from cataracts and worried about blindness. Medicare does cover cataract surgery when it is deemed medically necessary, which is in many cases. Not only will the surgery be covered but so will any before or after care required. Of course as with anything else with Medicare you may still have to pay a bit in the form of a deductible or copay. However, this is when cataracts progress to a serious stage. Before that, your doctor may recommend some other interventions.

In early stages, you may use a magnifying glass to see more clearly, or use anti-glare sunglasses that help you see well in bright light. As the condition progresses, your vision will get worse and these solutions just won’t help as much anymore.

How much of the procedure Medicare covers will depend on whether you have it as an inpatient or outpatient procedure. If you have it in the hospital as an inpatient procedure, it will be covered under Medicare Part A. This means everything will be covered. If you have it as an outpatient procedure, you may have to pay 20% of the costs, or any deductible that applies as part of Medicare Part B. This part of Medicare will also cover any special glasses you need to help with your recovery as well.

Other options to have your surgery covered under Medicare include the use of a Medicare Advantage plan, which is part of Medicare Part C. This is a plan that is meant to be both Medicare Part A and Part B, in one plan from a private provider that is contracted with Medicare to provide these plans. If you want to have some of your other expenses through Medicare covered you can also get coverage through Medigap, which has 10 different plans to choose from that cover some things like deductible and coinsurance, and even medical procedures that happen when you’re out of the country.

So, when you get cataracts you are no longer relegated to a life of blindness like you would have been before this easily done surgery. Most people have it as an outpatient procedure unless there are other indications of something that would make it so you would want to stay in the hospital. Medicare covers almost everything related to cataracts surgery, including glasses you might need afterwards, so don’t hesitate to ask your doctor if this procedure is right for you and you are on Medicare.