Healthcare has been greatly enhanced over the years, with the use of sophisticated medical equipment for efficiency and the aspects of healthcare insurance for affordability.
Before now, so many individuals were unable to access quality healthcare, and some have lost their lives due to poor access. Well, this is not the case today. In fact, with Medicare expansion and the availability of Medicare plans all around, individuals now have access to the best quality of healthcare regardless of their health status.
Although there are requirements that would be met before an individual is eligible for Medicare plans, it is one of the most effective ways for those eligible to sustain their health. People with disabilities, as well as older adults, make up the bulk of the individuals that are enrolled under Medicare.
Most of these people are restricted by the limited nature of Medicare coverage. Well, although this is a broad misconception, it is not far-fetched. Medicare only offers coverage for medically necessary health services, anything outside that would not be attended to.
Notwithstanding, with Medicare, you can get coverage for a very wide variety of illnesses, especially when you consider the effectiveness of alternative Medicare plans. One of the common health challenges amongst seniors is eye cataracts.
Characterized by cloudy lenses and other discomforting symptoms, cataracts are widespread amongst older adults and if left unchecked, can lead to blindness. A lot of times, Medicare recipients or aspiring Medicare beneficiaries ask for the depth of Medicare coverage, and one of the many services they usually seek is the coverage of cataract surgery.
Well, Medicare is a health insurance company that places the overall health of its beneficiaries as a top priority; hence health services that are considered a priority are often covered. The coverage of Medicare for a particular ailment will depend on Medicare’s perception of the person’s condition, and this is based on the type of disease and its severity.
Generally, Medicare offers health insurance coverage for regular cataract surgeries when it is medically necessary and prescribed by a qualified physician. To utilize Medicare cataract surgery coverage, the physician or hospital has to accept Medicare coverage. Else you might still have to pay yourself.
Based on 2022 research, about 50 percent of elders have cataracts, and most of them have undergone surgeries at least once before they are 80. It is only logical for Medicare to offer coverage for cataract surgeries when you consider the fact that Medicare subscribers are most susceptible.
The elders are susceptible due to their age, and the disabled, if not well taken care of, might be exposed even though this is very rare. Older individuals are usually more susceptible with age because of the breakdown of the proteins in the lens. Thus, breakdown leads to cloudiness in the lens which can lead to blurry vision.
Based on recent research, in 2022, about 4 million people underwent cataract surgeries in the United States every year. It is, however, good for individuals to know that the recent cataract surgeries can help them restore normal vision, and these services are available under Medicare health insurance coverage without much fuss.
How Is Laser Cataract Surgery Covered By Medicare?
Recent studies have shown that one of the most effective ways of restoring normal vision for a cataract patient is by performing a Laser Cataract Surgery, one that would help restore the individual’s normal vision by surgically removing the cloudy cataract lens and replacing it with a normal one.
This service is broadly covered by Medicare, judging from how medically important it is. Based on the Medicare plan, the individual utilizing Medicare would pay for the expenses. Also, other factors like the severity of the disease as well as the health insurance company determine the extent to which the Medicare coverage would be explored.
Here we will talk about the various Medicare plans available and how they can cover the cost of laser cataract surgery.
Original Medicare (Part A)
Original Medicare is split into two, Part A and Part B, all of which offer 80% coverage for the cost of Laser Cataract Surgery, and the individual would have to pay for the remaining 20% themselves; sometimes, they could get additional plans.
The Medicare Part A plan, however, only covers inpatient expenses of laser cataract surgery. This is mostly a hoax, as most laser cataract surgeries do not require patient care.
Notwithstanding, in some cases, especially when there are complications, prolonged recovery or the patient has extra health issues, Medicare Part might step in to offer coverage that might include accommodation costs, drug prescriptions, and payment for surgeries sometimes.
To benefit from the Medicare Part A plan, the individual is required to completely pay the Part A deductibles.
Original Medicare (Part B)
Medicare Part B is just like the Part A plan, with identical health insurance coverage. This original Medicare Plan Also covers laser cataract surgeries, but unlike Part A, Part B only covers outpatient expenses.
This means Part B would cover the cataract expenses if the person doesn’t have to remain in the hospital. Cool right?
Well, to enjoy these benefits, you would have to be eligible and must have paid your own 20% in deductibles. Hence, as much as you’re not being admitted, Medicare Part B would be responsible for your laser cataract surgery expenses.
Sometimes Original Medicare coverage is just so stiff and not enough, especially for patients that need a wide variety of services with unusual prognoses. With Medicare Advantage, also called Part C, recipients can get alternative coverage with extra benefits to those offered by the original Medicare plans.
However, Medicare Advantage plans mostly require copays, and there are certain other technicalities involved too. The main reason you’d go for a Medicare Advantage plan when you already have access to an Original Medicare plan is to get additional coverage that is not covered by the original Medicare plan.
Nevertheless, the extra laser cataract surgery services would differ by insurance companies. You should research to ensure you do not subscribe to a plan that doesn’t offer the extra service you need.
Medicare Part D Plan
Sometimes, the prescription coverage for laser cataract surgery is quite enormous, and even the Original Medicare plan might be just not enough if care is not taken, the individual ends up spending more than is anticipated. Well, this shouldn’t be the case, especially when you have Medicare Part D coverage.
Individuals under the Medicare Part D plan do not usually have issues when it comes to drug prescriptions; the insurance would almost always pay for their drug prescriptions.
Medicare Supplement plans
Some laser cataract plans might be quite expensive, hence, the idea of looking for additional medicare plans for the best possible coverage. Also called Medigap, the Medicare Supplement plan helps to pay for services that are not part of the Original Medicare benefits. In this case, it helps to pay the 20% fee for the individual.
Of course, the Medicare supplement plan isn’t free, but it is still very worth it when the individual’s out-of-pocket expenses are quite high. To be eligible for a Medigap plan, the individual should be enrolled under Medicare Parts A and B.
Check on Medicare Advantage vs Medicare Supplement Plans before choosing the right plan.
Free Cataract Surgery For the Elderly In 2022 With Medicare Plans
The healthcare of older adults is a big priority when you consider the vulnerability that comes with old age. Cataract, amongst many other diseases, is a very common ailment among older adults.
Even though we can access quality healthcare via Medicare and other health insurance plans, these plans still require payment on the path of individuals, and most elders are retired and may not be able to afford the required amount.
Notwithstanding, Medicare expansion has left room for a lot of flexibility and exceptions as regards plan affordability. Hence, with the right requirements, elders can now qualify for free plans. These requirements, however, differ between health insurance companies.
Exceptions to Medicare Coverage for Cataract Surgery
As much as Medicare would cover medically necessary and physician-approved laser cataract surgery, certain requirements must be met before it is possible. These requirements vary between regions and insurance companies.
It’s often advised that individuals verify if they meet up to the requirements before applying for a plan, this will help you get a proper idea of what to expect and what not to expect.
Here we will talk about some of the exceptions that are linked to cataract surgery via Medicare.
- Medicare will not cover the remaining 20% under any circumstance unless you get an additional plan.
You should also note that this 20%, which is the individual’s share of the cataract surgery expenses, depends on the type of operation.
- Charges like deductibles and medications are also excluded.
- Medicare pays identical amounts for cataract surgery, whether a laser is used or not. Hence, any extra expenses incurred by using a laser would have to be sorted elsewhere.
- For those using lasers for their cataract surgeries, Medicare would not provide or pay for special lenses like intraocular lenses (IOL), multifocal and toric lenses.
As long as you are qualified, it is quite easy to get a Medicare plan in 2022. All you need do is browse the service providers around you and get things rolling.
It might not be as easy as it sounds, though, but if you’re an American adult above 65 years of age or have a form of disability and have received more than 22 social security disability arms then you sure are on the right track.
Frequently Asked Questions
Is cataract laser surgery covered by medicare?
Typically, your Medicare plan would not cover costs for vision health services. But if it comes down to having standard cataract surgery, especially for people who are under the Medicare plan and aged 65 or above.
If it’s an Original Medicare plan, you may even get the required coverage to procure some corrective lenses when the standard cataract surgery requires the procedure to include an IOL implantation.
For laser cataract surgeries, however, Medicare would still offer some coverage. With Medicare Part B, you get the coverage you need as it applies to the cost approved by Medicare for cataract surgery. You’ll be required to pay a 20% copay amount of the Medicare Part B plan, though, as well as the deductibles that accompany the plan.
What parts of Medicare cover cataract surgery?
With Medicare health insurance coverage policies, you can get good coverage for the traditional cataract surgeries needed.
care Part B which is the outpatient insurance aspect would cover the greater part of the expenses related to the cataract surgery, mostly about 80%. Apart from this 80% coverage, the Medicare Part B plan would also give a free pair of glasses to the patient after the eye health service or cataract surgery.
Medicare Part A covers hospitalization costs. That’s why it’s the inpatient insurance part of the Medicare plan. So, if the patient is requested to be admitted to the hospital after the surgery, which is mostly not necessary and usually uncommon, the Medicare Part A aspect would cover the extra expenses on accommodation fees.
Medicare Part C or Medicare Advantage plans are mostly an alternative to the Original Medicare plans. So, this part of Medicare would operate like the Original Medicare for cataract surgeries.
Medicare Part D is the drug coverage part and covers the costs – mostly only partially, for any drugs the health professionals or doctor would prescribe after the surgery.
If you already have a Medicare Advantage plan, you won’t be allowed to procure a Medicare Supplement plan anymore. Medigap plans or Medicare Supplement plans are coverage plans that are usually private and help pay up the remaining 20% of the costs left by an Original Medicare plan. And this would include copays, deductibles, and out-of-pocket costs.
Is cataract surgery covered by Medicare Part B?
Yes, Medicare Part B covers a major part of the expenses incurred from eye cataract surgery. The insurance plan would pay for about 80% of the health costs. And you have to pay the rest 20%, which is mostly out-of-pocket expenses, deductibles, and copayments.