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Medicare and Cataracts: What to expect from Original Medicare when you need cataract surgery

Cataracts are the leading cause of blindness in the world. Cataracts can occur at any age, but are most common later in life. Cataracts are so common in seniors, that cataracts are considered part of the aging process. If you're on Medicare, you should be aware of causes, symptoms and treatments for cataracts. Medicare does cover surgery for cataracts as well as glasses or lenses that may be needed following the surgery.

Causes of cataracts

Cataracts are a clouding in your eyes' natural lenses. You can have cataracts in one eye or both. Once cataracts form, the lens becomes increasingly opaque. Cataracts interfere with light getting through to your retina. The actual cause of cataracts is unknown; however, the breakdown of lens proteins and other chemical changes associated with aging are contributing factors with cataracts. Trauma, inflammation, and the prolonged use of corticosteroids may be associated with cataracts in younger people.

Symptoms of cataracts

With cataracts, how you see colors, headlights, and sunlight may change. Double vision can occur in people with cataracts if the cataracts cause a difference in the degree of opacity in one part of the lens over another. While none of the symptoms automatically mean you have cataracts, they are commonly associated with cataracts.

Types of cataracts

Multiple cataracts are possible in more than one part of the eye.

  • Nuclear cataracts are in the central part of the eye
  • Cortical cataracts are located in the cortex, which surrounds the center of the eye
  • Posterior subcapsular cataracts are at the back of the lens.

Treating cataracts with surgery

Having surgery to correct cataracts doesn't have to be scary. In fact, if you have cataracts, you may not need surgery at all. Your doctor may present other options to treat cataracts. Medicare may cover non-surgical medical treatments for cataracts depending on necessity and type.

If you have cataracts in both eyes, you'll have the surgery on one eye at a time. The correction of cataracts in one eye may be enough to improve your vision.

To fix cataracts, the natural lens in the affected eye is replaced with an artificial lens. Surgery for cataracts is usually done on an outpatient basis. Millions of people have cataracts removed every year; 98% of the surgeries are successful and complication free.

You won't need thick glasses for cataracts after the surgery, but you may need reading glasses even after your cataracts are removed. While free from cataracts, your vision will continue to improve in the weeks after your surgery. Cataracts can never return to an eye because, during the surgery, the entire lens is removed and replaced with an artificial lens that cannot develop a cataract.

Medicare and cataracts

Surgery to correct cataracts is usually performed in people over age 65, which includes Medicare recipients. That's why it's so important to know how Medicare covers the treatment of cataracts.

Surgery to remove cataracts is covered by Medicare. Medicare only pays expenses directly related to the cataracts. If you had a non Medicare-covered condition before developing cataracts, you may be able to treat that during the same surgery, but Medicare will only cover the costs associated with cataracts. Medicare will ask the surgeon to bill you separately for the parts not related to the cataracts.

Because an ophthalmologist (not an optometrist) performs surgery for cataracts, Medicare covers the surgery under Medicare Part B. Medicare covers fees from your ophthalmologist and the facility, but only amounts approved by Medicare. You will pay a 20% Medicare Part B coinsurance for the surgery plus your Medicare deductible.

With cataracts, Medicare covers a pre-surgery exam to discuss your cataracts, and anesthesia during the surgery. Medicare also covers any follow-up care. You'll pay the 20% Medicare coinsurance, plus any Medicare deductible before Medicare pays its share.

Normally, Medicare does not cover routine vision correction. Medicare does cover eyeglasses, contact lenses or intraocular lenses following surgery to treat cataracts. Make sure your supplier is enrolled in Medicare and has a Medicare supplier number. Medicare won't pay your claim if your supplier doesn't have a Medicare supplier number.

Medicare Part B only provides coverage for standard frames. For more expensive frames, you'll pay the difference over the amount approved by Medicare. Ask your doctor what frames are covered by Medicare. You'll pay 20% of the amount approved by Medicare (your Medicare Part B coinsurance), plus your Medicare deductible. Remember to tell your doctor to send the bill for your eyeglasses or contact lenses to Medicare.

You can call Medicare at 1-800-MEDICARE for more information on Medicare coverage of cataracts surgery and treatment.

Medicare has neither reviewed nor endorsed this information.

eHealth Medicare is operated by eHealthInsurance Services, Inc., a licensed health insurance agency certified to sell Medicare products.
Medicare has neither reviewed nor endorsed this information.