Medicare and Eye Surgery

Routine eye care is essential at any age but becomes critical when we reach our senior years. One in every three people is at risk for suffering from a vision-related condition by the age of 65. It is why regular eye screening is recommended for seniors.

Common causes of vision loss among seniors are glaucoma, diabetic retinopathy, and cataract.

Medicare, in general, does not cover vision care but will pay for medically necessary services such as cataract surgery. These services are covered under Original Medicare Part B (medical insurance). Medicare covers certain eye services for chronic eye conditions, including cataracts or glaucoma.

Eye surgery for chronic eye conditions that helps repair or restore normal eye functioning is covered under Medicare. It includes surgery to remove a cataract and to replace an eye lens with a fabricated intraocular lens.

Medicare will also pay for a standard pair of prescription eyeglasses or contacts if needed after eye surgery. In some cases, coverage includes customized eyeglasses or contact lenses if deemed necessary.

Medicare covers eye surgeries for cataract regardless of the procedure. It covers eye surgeries, whether it is performed using the latest computer-controlled lasers or traditional surgical techniques. No matter the treatment employed, Medicare covers and pays for the removal of the cataract and insertion of a conventional intraocular lens.

People who are experiencing vision problems that may indicate a serious eye condition and require an eye exam can be covered under Medicare. This is covered even if the eye exam is negative for a vision problem.

Glaucoma is a disease that can result in vision loss. This is an eye condition caused by a buildup of pressure inside the eye. If left untreated, it damages the optic nerve and results in permanent vision loss. Glaucoma treatments such as outpatient laser surgery are covered under Medicare Part B.

A detached retina is an emergency medical condition that can result in permanent vision loss if not treated immediately. Surgery to repair a detached retina is covered under Medicare Part B.

How Much Will Medicare Pay?

Medicare Part B (medical insurance) covers eye surgeries for cataract, glaucoma, and a detached retina. In cataract surgery, for example, Medicare covers the cost of the pre-surgery exam and post-surgery care.

Patients generally pay for the 20 percent coinsurance amount for eye surgery. Medicare only pays after the patient pays for the Medicare Part B deductible.

Some people may require the use of eyeglasses after cataract surgery. In such cases, Medicare Part B pays for the contact lenses or eyeglasses from a Medicare-supplier. Patients must also pay 20 percent of the Medicare-approved amount.

It is difficult to determine the exact costs of eye surgery or treatments (pre-surgery and post-surgery). People who are planning to undergo eye surgery for a Medicare-covered eye condition are advised to speak with their health provider for the total costs of treatment.

Consulting your health insurance provider can also give you an accurate assessment of how much Medicare pay and what treatments and services are covered.