The National Eye Institute (NEI) reported that “the risk of cataract increases with each decade of life, starting around age 40.” Studies by the NEI have also shown the number of cataract cases increased 20% from 2000 to 2010.
They estimate that by the year 2050, “the number of people in the United States with cataracts is expected to double from 24.4 million to about 50 million.”
Cataracts are becoming more prevalent with every passing year, which means the need for cataract surgery is increasing, too. With this need comes the call for advancements in technologies used for cataract surgery. Advancements in technology enable treatment options that are progressively effective and efficient.
A variance in treatment options means a variance in treatment costs. There is no fixed cost of cataract surgery. The average cost will vary based on the technologies used, the severity of the patient’s cataract, the type of cataract surgery, the type of intraocular lens (IOL) implanted, and the patient’s health insurance coverage.
What Are Cataracts?
A cataract is essentially a clouded area on the natural eye lens. This condition is an eye disease that progresses gradually over time. As protein accumulates on the outer eye lens, it begins to block light from reaching the optic nerve.
This is how vision loss occurs. When the optic nerve is no longer able to perceive light, it loses its ability to perceive vision all together. Without light, the optic nerve doesn’t understand what it’s seeing, and is not able to translate that information to the part of the brain that makes sense of our vision.
Cataracts typically develop when a person is in their 40s or 50s, but they begin to hinder a person’s vision at about 60 years old. If left untreated and allowed to grow for years, cataracts can lead to complete vision loss.
The purpose of cataract surgery is to remove or dissolve cataracts from the outer eye lens. These procedures typically include the removal of the clouded eye lens, along with the implantation of an artificial lens known as an IOL (intraocular lens). Implantation of a clear, artificial eye lens is proven to effectively repair a person’s vision.
Types of Cataract Surgery
- The most common type of cataract surgery, phacoemulsification cataract surgery, utilizes foldable intraocular lenses (IOL) implants. During this type of cataract surgery, the ophthalmologist removes the cloudy cataract lens using an ultrasonic probe, and replaces the cloudy lens with a folded lens implant that unfolds when it’s set in place.
- During the extracapsular cataract surgery, the ophthalmologist removes the natural eye lens, but leaves a part of the posterior lens capsule in the eye. This allows implantation of an artificial IOL, without a major incision, to restore the patient’s vision.
- Intracapsular cataract surgery, one of the least common types of cataract surgery, involves the removal of the eye lens as well as the entire eye lens capsule to be replaced with an IOL. Due to the sizable incision made during this procedure, intracapsular cataract surgery has a higher rate of risks and complications.
- Laser cataract surgery has the same function as standard cataract surgeries, but this procedure uses advanced femtosecond lasers (which is an infrared laser with the ability to pulse more quickly and accurately) instead of hand-held tools to make incisions in the eye lens. As laser cataract surgery is the most technologically-advanced type of cataract surgery, it is also the most expensive.
Depending on the type of cataract surgery, the expertise of the cataract surgeon, and the type of IOL implanted, standard cataract surgery cost (out-of-pocket) can range from $3,000 to $5,000 per eye. (Monofocal IOL are relatively low-cost lenses, while toric and multifocal IOL are on the more expensive side of the spectrum.)
Advanced types of cataract surgery, like laser-assisted cataract surgery or procedures using advanced toric IOL, can average about $4,000 to $6,000 out-of-pocket, per eye.
Fortunately, Medicare insurance covers standard cataract surgery for people who are 65 years and over. Most people don’t pay the out-of-pocket costs for basic cataract surgery.
Does Medicare Cover Cataract Surgery?
Medicare health insurance will cover standard cataract surgery. Most private insurance plans will cover this procedure too.
The amount of the cataract surgery cost covered by Medicare insurance will vary based on the specific Medicare plan (A, B, C, or D), the type of cataract surgery, any pre-existing conditions the patient has, and whether the procedure is done at a surgery center, clinic, or hospital.
Health insurance can cover a large portion of the cataract surgery cost, but the patient may be responsible for out-of-pocket costs, like physician/surgeon fees, any copayments or deductibles. Patients will also be responsible for out-of-pocket expenses if they choose a premium IOL, toric lens or multifocal lens implantation, instead of a standard monofocal lens.
Medicare covers the parts of cataract surgery that are deemed medically-necessary. Patients will be responsible for any additions that aren’t considered essential.
Medicare health insurance will cover:
- Extraction of the cataract
- Implantation of standard, monofocal lens
- One pair of prescription eye glasses or contact lenses
Cataract Surgery Cost Breakdown with Medicare
Medicare Part B will cover standard cataract surgery, along with ophthalmologist fees and surgery center fees. Although, this health insurance will only cover Medicare-approved amounts; Medicare won’t cover the complete cost of the procedure.
Patients are responsible for meeting their deductible, as well as a 20% Medicare Part B copay.
As a general example, a standard cataract surgery in a clinic or surgery center may cost about $3,500. A patient with Medicare insurance coverage will be responsible for $700 (a 20% copay). The total out-of-pocket cost will also include the deductible amount, which depends on the patient’s specific insurance plan.
Without Medicare coverage or private insurance coverage, the average cost of cataract surgery can run a person the full $3,500 for surgical procedures at a clinic.
The total cost of cataract treatment for a patient who doesn’t have an insurance provider can range:
- $3,000 to $5,000 per eye for standard cataract surgery
- $4,000 to $6,000 per eye for laser-assisted cataract surgery or procedures using advanced lens implants
Questions to Ask Your Insurance Provider
If you’re actively seeking an Orlando ophthalmologist, there’s a good chance you’re also considering the cost of cataract surgery and the amount covered by your insurance company.
Every insurance company is different. While some insurance plans may offer a low deductible and copay with high monthly payments, other insurance companies may offer a relatively high deductible and copay with lower monthly payments.
To gain an accurate understanding of the cost you can expect to pay for cataract surgery, ask your insurance provider the following questions:
- What is my copayment amount?
- What is the cost of my deductible?
- Does my insurance plan cover prescription eyeglasses after the procedure?
- Is the cataract surgeon a preferred provider with my insurance company?
- Is the clinic or surgery center in-network with my insurance plan?
- Does my insurance provider need to verify that this procedure is medically-necessary, prior to treatment?
Asking each of these questions to your insurance provider can make a difference in the out-of-pocket costs of treatment as well as your experience throughout the treatment process.
If you don’t ensure that your procedure is covered by your insurance provider, you may end up with a much larger cost than you anticipated. If the surgical center or cataract surgeon is not in-network with your insurance plan, you may be facing higher costs as well. Cover all of your bases and ask the essential questions so you don’t receive a surprising bill post-treatment.
Throughout all UCF Health Services, it’s our goal to ensure that each of our patients is as informed as possible. We are transparent with our patients, because we believe you deserve a provider with integrity. Dr. Mehul Patel, our comprehensive ophthalmologist, has a passion for cataract surgery, thorough patient education, and enabling optimal vision for all patients.
When it comes to eye care and treatment options in cataract surgery, we strive to provide you with the knowledge that allows you to make an informed decision for your health.
John Hopkins Medicine: https://www.hopkinsmedicine.org/wilmer/conditions/cataracts_faq.html
All About Vision: https://www.allaboutvision.com/conditions/faq-cataract-surgery-types.htm