Medicare Can Help with Cataracts

Cataracts typically develop as the human eye ages.

Cataracts often come with age and can affect anyone’s vision. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. New eyeglasses, brighter lighting, anti-glare sunglasses or magnifying lenses may help symptoms. If not, surgery may be necessary.

What is a cataract and what causes it?
A cataract is a clouding of the lens in the eye that affects vision. The lens lies behind the iris and the pupil. It works much like a camera lens, focusing light onto the retina at the back of the eye, where an image is recorded.

The lens also adjusts the eye’s focus, allowing clear focus of subjects both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and allows light to pass through it.

As we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Researchers suspect that there are several causes of cataracts, such as smoking and diabetes. Or it may be that the protein in the lens just changes from wear and tear over the years.
A cataract can occur in either or both eyes, but it can’t spread from one eye to the other.

How can Medicare help?
Medicare can help with cataracts, their treatment and surgery. After surgery, Medicare helps pay for cataract glasses, contact lenses or intraocular lenses from an ophthalmologist. Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses (one pair of eyeglasses with standard frames or one set of contact lenses).

Medicare covers the surgery if it’s done using traditional surgical techniques or using lasers. Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare. This is true no matter who submits the claim.

With Original Medicare patients pay 20 percent of the Medicare-approved amount for one pair of eyeglasses or one set of contact lenses after each cataract surgery with an intraocular lens. Patients pay any additional costs for upgraded frames. The Part B deductible ($183 in 2018) applies.

With surgeries or procedures, it’s hard to know the exact costs in advance. This is because no one knows exactly what services will be needed. With surgery or a procedure, patients may be able to estimate how much they’ll have to pay. 

Patients may ask the doctor, hospital or facility how much the surgery and any care afterward will cost. Inpatient or outpatient status can make a big difference in cost.

Patients should also check with any other insurance they may have to see what it will pay. Other insurance might include: Medicare Supplement Insurance (Medigap), Medicaid or coverage from an employer.

More information on cost of treatment is available at MyMedicare.gov, or look in the last “Medicare Summary Notice.”

Don’t forget to check your Part A deductible if you expect to be admitted to the hospital. Check the Part B deductible for a doctor’s visit and other outpatient care. Be sure to pay the deductible amounts before Medicare starts to pay. After Medicare starts to pay, copayments may start to apply.

 

Greg Dill is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada and the Pacific