Cataract surgery is common in the US, but can be expensive if insurance doesn’t pay for it. Without private insurance or Medicare, the out-of-pocket expense can range from $3,000 to $7,000 per eye. With insurance or Medicare, traditional monofocal cataract surgery is typically covered, but additional costs such as copayments and medication may apply.

The overall cost depends on the lens type, eye conditions, and surgery method. It’s crucial to openly discuss these expenses with your surgeon before scheduling the surgery to avoid unexpected charges. Contacting your insurance or Medicare representative for a clear understanding of your coverage is also recommended.

What is cataract surgery?

Cataract surgery is a procedure conducted by an ophthalmologist to remove the cloudy lens in your eye. A healthy lens is typically clear, whereas a damaged one appears cloudy. The surgery involves the removal of the damaged natural lens and its replacement with a clear artificial lens.

How much does cataract surgery cost?

Insurance and Medicare typically pay for cataract surgery. However, the amount you pay can vary based on factors such as your surgeon, the type of lens used, and the surgical technique. Out-of-pocket expenses may include copayments, deductibles, and medications.

For those without insurance, the cost of cataract surgery on both eyes can range from $6,000 to $12,000. This cost encompasses the surgery itself, implantation, consumable surgical equipment, as well as technical, professional, and surgery center fees. Many surgeons offer payment plans for individuals paying out of pocket. Additionally, you can utilize a health savings account (HSA) to cover out-of-pocket expenses. 

Many things can affect how much cataract surgery costs, like the type of procedure and lens used. Here are some of the key factors that contribute to the overall price of a cataract surgery procedure.

Types of cataract surgery

Four main surgical techniques are used for cataract surgery. 

• Phacoemulsification is the most common technique used to remove a cataract. This is utilized during a standard cataract procedure and is covered by private insurance and Medicare. 

• Extracapsular cataract removal and intracapsular cataract surgery are less common techniques. The surgeon makes a bigger cut in the eye to take out the lens in one piece. These technique may result in more complications and slower healing than surgeries that involve a smaller incision.

• Laser-assisted cataract surgery involves using optical coherence tomography. Laser cataract surgery is the newest technique and is generally not covered 100% by private insurance or Medicare. 

How the procedure is done and the type of lens used can greatly affect how much the procedure costs. Opting for laser cataract surgery can amount to approximately $5,000 per eye.

Cataract Lens Cost

There are multiple options for lenses. The most widely used are fixed-focus monofocal lenses, accommodating monofocal lenses, toric lenses, and multifocal lenses.

Private insurance and Medicare usually pay for monofocal lenses. Toric lenses start at around $1,500 each, while specialized lenses start at around $3,000 each. Specific specialized lenses such as presbyopia lenses and astigmatism lenses will have additional costs.

Other underlying eye conditions

During cataract surgery, astigmatism can also be fixed. If you have this combination procedure, then a special intraocular lens called a toric lens must be used. The amount of astigmatism before surgery will decide if it can be fully fixed or if you’ll still need glasses.

Using a special toric lens may cost extra money for your procedure that your insurance or Medicare may not pay for. Specific costs will depend on the surgeon and their billing costs.

It is important to discuss with your healthcare provider potential out-of-pocket costs for the procedure. Unfortunately, if you have astigmatism and a cataract, only one lens can be implanted.

Cataract surgery cost with private insurance

All major private insurances cover cataract surgery. Most insurances will cover traditional monofocal lens implants; however, if you are interested in a multifocal lens implant, there may be out-of-pocket expenses. These expenses will depend on your insurance.

Before surgery, speak to your insurance provider and ask questions regarding the financial aspects of the surgery. Some questions to ask might be:

• How much is my copay?
• Is anesthesia covered?
• Is the surgical center covered?
• Is the anesthesia group at the surgery center covered?
• Do I need a pre-approval?
• Is there a specific surgeon I need to use?
• Are postoperative appointments covered?
• Are post-surgery medications used?

Does Medicare cover the cost of cataract surgery?

Cataract surgery falls under Medicare Part B since it is usually an outpatient procedure. Medicare Part B covers doctors’ services and outpatient procedures. Medicare covers the cost for:

• Removing the cataract,
• Monofocal lens implants,
• One set of prescription contact lenses or eyeglasses following surgery.

This is standard cataract surgery. If you are uncertain about your specific Medicare coverage and the options available to you, it is advisable to consult a Medicare representative before undergoing cataract surgery.

Medicare Part B necessitates that the patient covers 20% of the approved amount. Should you wish to reduce or eliminate the need for glasses or contact lenses post-surgery, there might be extra expenses associated with upgrading to a different artificial lens. It is crucial to have a conversation with your surgeon regarding your Medicare coverage to understand the surgical technique they will be employing, thus avoiding any unexpected costs.

Flexible or Health Spending Account

A Flexible Spending Account (FSA) is a designated account where you can allocate funds to cover specific out-of-pocket healthcare expenses, such as surgeries and medications. Contributions are deducted from your paycheck before income taxes are applied, making the FSA funds tax-free.

This account can be used for insurance deductibles, copayments, and eligible medications. By utilizing pre-tax funds, you can save money. You will receive either a debit card for medical expenses or need to provide receipts and documentation for reimbursement.

Outcomes

Determining the most suitable surgical technique and lens for you is contingent upon your post-surgery objectives. If you are comfortable with wearing glasses or contact lenses, opting for standard cataract surgery with a monofocal lens could be a viable choice. This procedure is typically covered by private insurance and Medicare, with a copayment and deductible. However, if you prefer not to rely on contacts, upgrading to a different lens or a more advanced surgical method might involve additional out-of-pocket expenses.

It is crucial to consider your financial situation when discussing surgical options with your healthcare provider. Having the means to cover extra costs may open up more options for you. Nevertheless, if financial constraints are a concern, the standard cataract surgery remains a highly safe and effective choice. Remember, a higher price tag on a specific technique or lens does not necessarily equate to superior quality.

Depending on your eye condition, an alternative to the standard cataract procedure may be necessary. In some cases, there might not be any other alternatives. If this is the scenario, consult with your surgeon and your insurance provider to ascertain the specific out-of-pocket expenses.

Contact SightMD today to schedule an appointment with one of our doctors to discuss your vision health at one of our convenient locations!