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The Cost of Cataract Surgery

Cataract Surgery Cost Cataract surgery has come a long way in the last decade. Not only is it now a fairly straightforward surgical procedure, itís also one of the most commonly performed surgeries worldwide, with over a million performed each year in the United States alone! So while the surgery may seem scary and new to you, you can relax knowing that itís just another day at the office for your surgeon.

Cataract surgery is performed under local anesthetic and takes only about 15 minutes per eye, though up to an hour of recovery time may be required at the clinic before you can go home. If surgery is necessary for both eyes, it is generally only performed on one eye at a time and two weeks apart. Consequently, the cost of this procedure is quite reasonable compared with other surgical procedures, and can vastly improve your quality of life.

While some costs of cataract surgery are standard, other costs are variable, particularly with regard to the type of intraocular lens (IOL) implant that is chosen. The basic procedure and standard monofocal intraocular lens is usually covered by Medicare or your medical insurance but you will also need to budget for any out-of-pocket expenses for additional tests, premium IOLs and possibly reading glasses.

What is the basic cost of cataract surgery?
According to a leading industry analyst, basic cataract surgery in the US would cost around $3,363 per eye in 2009, if you had to pay for everything yourself and chose a monofocal intraocular lens. If you want a high-tech, presbyopia-correcting IOL then costs would rise to around $4010 or more per eye. Costs vary between states and between surgeons so it may be worth getting several quotes before committing to the cataract procedure. Keep in mind though that the cheapest option isn't necessarily the right one for you. This is an eye surgery that you're shopping for after all, not a ham sandwich. There are other factors to consider, such as the surgeon's experience and success rate.

What about medical tourism?
Some people choose to take advantage of lower costs with medical tourism. They may travel to Central America and have the surgery performed at much lower cost, but often for typical cataract surgery the savings make it hardly worth considering this drastic move. Cataract surgery in Panama at a top hospital costs around $2500 while in India it would cost less than $1000. However, flights and accommodation, especially if traveling with a partner, make the savings negligible compared to the risk involved if further surgery is necessary or complications arise.

What out-of-pocket expenses would there be?
Most people who need cataract surgery are covered at least in part by health insurance or by Medicare for the aspects of the cataract surgery which are deemed medically necessary. This would typically include a standard monofocal intraocular lens, but not a multifocal or presbyopia-correcting lens implant. As the natural lens is removed during surgery an artificial lens is considered necessary to restore your sight. This type of lens would give you good distance vision but you will still need to wear reading glasses for close work, which would not be covered unless you specifically had a policy which covered eyeglasses.

A presbyopia-correcting lens will provide clear vision at different ranges and you may not need glasses at all. However, Medicare and most insurance providers consider these high-tech premium lenses medically unnecessary, and any extra costs directly associated with these more expensive lenses must be paid for by the patient themselves.

Why are reading glasses not covered?
If, after cataract surgery reading glasses are required, they will not be paid for by Medicare or by insurance providers unless you have a specific policy for eyeglasses. This may seem a little illogical and unfair but many people need eyeglasses for common refractive corrections such as nearsightedness or farsightedness. Even those eyeglasses, which are essential for reading and driving, must generally be paid for by the patient and likewise with reading glasses after cataract surgery.

How much can I expect medical insurance to contribute?
With straightforward cataract surgery, Medicare is very simple. It pays a standard agreed reimbursement to the eye surgeon and the surgical center. Private health insurance providers usually follow Medicareís lead and standard charges will be covered, subject to any co-pay agreement or deductible you may have on your individual policy.

Charges beyond the actual cataract procedure such as for a comprehensive eye examination to measure refractive errors, charges for optional anesthesia personnel and standard eyeglasses if required after surgery will cost Medicare patients 20% of the fees. Cataract surgery complications after 90 days, which may require YAG laser capsulotomy to clear any cloudy residual membrane, may not be covered and would cost around $300.

Speak with your Medicare representative or insurance provider before having cataract surgery so you know what is covered and how much you may need to save up for out-of-pocket expenses.

You need to know:

  • Your co-pay percentage
  • Your deductible to be paid before the insurance provider will pay the excess
  • Whether your insurance plan covers eyeglasses
  • Whether there is a preferred provider with pre-agreed fees
  • Whether advance approval must be sought before the surgery can proceed

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