When does vision insurance cover cataract surgery costs?

Vision insurance does not typically cover cataract surgery. However, the procedure is seen as medically necessary, so most private health insurance companies will partially, or entirely, cover basic cataract surgery. 

Will vision insurance cover cataract surgery?

The surgery is also covered by Medicare (under Medicare Part B). You can receive basic lens replacement, paid in full by Medicare up to $2,000, or opt to apply that amount to replacement lenses that also correct vision and pay the difference. Medicare will also cover corrective glasses or contacts required post-operation. 

Aside from your Medicare Part B deductible and 20% co-insurance payment, it's possible to have surgery without any out-of-pocket costs. 

What is included in cataract surgery?

Basic cataract surgery is an outpatient procedure that involves the removal of a diseased lens in your eye, replacement with an artificial intraocular lens (IOL), and one set of prescription eyeglasses or contact lenses for after surgery. 

The cataract is removed through one of two procedures: phacoemulsification or extracapsular cataract extraction. 

Phacoemulsification. In this procedure, an eye surgeon breaks up the lens in the eye with an ultrasound probe. The doctor creates a small incision in the cornea using a scalpel. 

There, he or she will insert a needle-thin probe behind the pupil to break up the diseased lens with ultrasound waves and suction out fragments. Once the lens capsule is cleared of debris, the surgeon can insert the IOL before stitching up the cornea. 

Extracapsular cataract extraction. The lens is removed from the eye in one piece with this procedure. The surgeon uses tools to make a larger incision and removes the front capsule of the lens along with the cloudy lens. 

As with phacoemulsification, the lens capsule is left intact for placement of the IOL before the surgeon stitches up the incision. 

How much does cataract surgery cost?

Without Medicare or private insurance coverage, the cost of cataract surgery in the United States can range from $3,783 to $6,898, according to a report prepared for All About Vision by leading eye-care industry analytics firm Market Scope. 

The type of intraocular lens implanted in the eye, the technology used during surgery, the expertise of the surgeon, and the location of your eye surgeon will all impact the cost. 

Even with insurance, you may need to pay extra for costs indirectly related to the cataract surgery itself. For example, Medicare patients can expect to pay up to 20% of fees for an electrocardiogram (EKG) to determine heart health, a comprehensive eye exam, charges related to anesthesia, standard prescription eyeglasses to enhance vision post-surgery and follow-up procedures due to complications.  

Will cataract surgery improve my vision?

If you’ve had basic cataract surgery, your surgeon likely has used a monofocal IOL, which has a single-focus strength for distance vision. As a result, most people will need reading glasses to see up close. However, your overall vision will be clearer than it was with cataracts. 

There also are a few other intraocular lens types available, such as accommodating-focus monofocals, which respond to eye movements and shift focus between near and far. And there are multifocal lenses, which behave similarly to bifocals or progressive lenses, and toric lenses, which adjust for astigmatism. 

While your eye doctor may recommend these lens upgrades, they are not typically covered by insurance. That's because these additional issues — such as astigmatism or presbyopia — can be corrected with eyeglasses, which are covered by vision insurance. 

Make sure you know what is covered by your insurance before you schedule your surgery.  

Page published on Monday, April 13, 2020