Does Medicare Cover Cataract Surgery In Nevada?

Does Medicare Cover Cataract Surgery In Nevada

As we age, the risk for developing cataracts – a clouding of the eye’s natural lens – increases. More than half of all Americans have had a cataract or undergone surgery by the age of 80. As a resident of the Silver State, you may wonder “Does Medicare pay for cataract surgery,” to restore clear eyesight? The answer is that it does, but how much is covered, what you pay out of pocket, and how the program works, depends on the type of Medicare coverage you have.

A 3 Plan Breakdown - How Does Medicare Cover Cataract Surgery?

Medicare, the Federal Health Insurance Program for individuals aged 65+ provides coverage for cataract surgery under specific circumstances. However, the extent of your coverage varies depending on the type of plan you’re enrolled in.

Does Original Medicare Cover Cataract Surgery (Part A & B)?

Under Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance for outpatient services). Here is how it works:

1. Part A covers cataract surgery if it occurs in an inpatient facility, but does have deductibles and copays.

2. Part B covers a significant portion of the costs associated with cataract surgery, including the surgical procedure, pre-operative and post-operative care, one pair of eyeglasses/contacts, and the cost of the standard intraocular lens (IOL) implant.

  • You’re responsible for paying the annual Part B deductible ($240 in 2024), and 20% of the Medicare-approved amount for the surgery and related services.
  • If you choose a premium IOL, such as a Toric or Multifocal lens, you’ll have to pay an additional cost out-of-pocket.

This means that your cataract surgery under this plan is covered up to 80%, and the remaining 20% is your responsibility unless you have supplemental insurance or a Medicare Advantage Plan, which we’ll cover more on below.

How Does An Advantage Medicare Plan Pay For Cataract Surgery (Part C)?

A Medicare Advantage Plan (Part C) is offered by private insurance companies approved by Medicare, and is an alternative to Original Medicare. This type of Medicare does cover cataract surgery to the same extent as Original Medicare (Part B), but comes with additional benefits:

  • Lower copays or coinsurance rates for cataract surgery and related services.
  • Coverage for premium IOLs, which are not covered under Part B.
  • Additional vision benefits such as routine eye exams or discounts on eyeglasses or contact lenses.
  • May include coverage for prescription medications needed post-surgery, such as pain relief and eye drops.

The specific costs and coverage details vary depending on which Medicare Advantage Plan you have, so review your plan’s documentation for further information on this.

Supplemental Coverage Through Medigap

A Medigap plan, also known as Medicare Supplement Insurance, is designed to fill the coverage gaps in the Original Medicare (Part A and B), which can help cover the remaining 20% coinsurance for cataract surgery, as well as, deductibles and copayments that the Original Medicare doesn’t cover. The initial enrollment for this is a 6-month window that starts in the first month you have Medicare Part B and are 65+ or older.

Who Eligible For Medicare Cataract Surgery Coverage?

Medicare pays for cataract surgery coverage if you meet the following eligibility criteria:

  • You must be enrolled in a Medicare Part B or Medicare Advantage Plan.
  • Have documented medical necessity for cataract surgery as determined by an ophthalmologist.
  • Undergo cataract surgery at a Medicare-approved facility or with a Medicare-participating provider.

How Does Medicare Cover Cataract Surgery Facilities & Rehabilitation Services?

  • $1,906 at an ambulatory surgical center (ASC), of which Medicare pays $1,525 and the beneficiary pays $380 out-of-pocket.
  • $2,943 at a hospital outpatient department, of which Medicare pays $2,355 and the beneficiary pays $588 out-of-pocket

If the cataract surgery does not fully restore normal vision, rehabilitation services can help you adjust to remaining vision impairment. Medicare covers occupational therapy to learn adaptive daily living techniques, low vision aids like magnifiers, task lighting, and filters, as well as training on how to use vision aids effectively.

Schedule an Appointment Today

At Brimhall Eye Center, we understand navigating Medicare’s cataract surgery coverage can be complex, and knowing what’s covered and your potential costs is crucial for making informed vision care decisions. Our team will review your Medicare plan details and consult with you to ensure you budget properly and receive necessary cataract care you need. As Las Vegas’ cataract surgery experts, we’re here to answer your questions. Contact us at www.brimhalleyecenter.com or (702) 263-2020 to schedule a consultation – your first step towards clearer vision with our experienced ophthalmologists.

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