Does blue cross blue shield cover laser cataract surgery

How Much Does Cataract Surgery Cost?

The average cost of cataract surgery in the U.S. is between $3,500 and $7,000 per eye for someone without insurance.

However, Medicare and private insurance plans often cover all or a portion of the costs.

This can reduce your out-of-pocket expenses by 80 percent or more.

What Impacts the Cost of Cataract Surgery?

The main factors that affect the average cost of cataract surgery include:

• Type of lens. The type of intraocular lens (IOL) you need affects the overall cost. A monofocal lens that corrects vision at one distance is less expensive than a multifocal lens. Premium lenses include toric IOLs to correct astigmatism and presbyopia-correcting IOLs.
• Type of surgery. Traditional surgical techniques, such as phacoemulsification, are lower in cost. Laser cataract surgery uses the most advanced technologies and is the most expensive.
• Surgeon’s fees. A surgeon’s experience and reputation often affect their fees.
• Surgery setting. Ambulatory surgical centers typically cost less than outpatient surgery in a hospital.
• Pre- and post-operative care. Pre- and post-operative doctor’s visits, medications, and testing can impact the overall cost.

These variables will affect the on-paper cost of your cataract surgery. However, your health insurance coverage is the biggest factor in determining your out-of-pocket cost.

Does Medicare Cover Cataract Surgery?

Yes, basic cataract surgery is covered by Medicare. Your doctor must determine that the surgery is medically necessary for your health.

Medicare typically covers 80%of expenses related to cataract surgery. It also covers one pair of eyeglasses or contact lenses after the eye surgery.

Medicare Part A

Medicare Part A covers hospital stays and other inpatient procedure costs. Most cataract surgeries will not require the patient to remain overnight. But if yours does, your hospital expenses should be covered by Part A.

Medicare Part B

Medicare Part B covers medically necessary health care procedures and services.

Part B will cover:

• Your pre-surgery appointments
• The surgical procedure
• Monofocal lenses
• Post-surgery outpatient services.

Other Things to Consider 

Here are some things to think about regarding Medicare coverage:

• You will be required to pay your deductible and copayment
• Monofocal IOLs are covered by Medicare
• If you want premium IOLs, you will have to pay the difference these include:
  • Presbyopia-correcting intraocular lenses (P-C IOLs) 
  • Astigmatism-correcting IOLs (A-C IOLs)
  • Multifocal lens implants

These services can double or triple out-of-pocket expenses.

It is possible to purchase a “Medigap” policy from a private health insurance company. These plans provide supplemental coverage for health services not covered by Medicare. They often cover the additional costs of premium cataract eye surgery. 

Speak directly with your Medicare representative before having cataract surgery. They’ll help you to determine the total cost of your operation.

Does Private Health Insurance Cover Cataract Surgery?

Most private health insurance providers consider cataract surgery to be medically necessary. Therefore they will cover at least a portion of the costs associated.

Insurance providers who will cover a significant portion of your cataract surgery include:

• Cigna
• Aetna
• United Healthcare

Speak directly with your healthcare provider to find out what your plan covers. Using FSAs and HSAs to Pay for Cataract Surgery

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) can help pay for eye surgery.

Flexible Spending Accounts (FSA)

An FSA allows you to pay for many medical expenses using pre-tax income from your employer. Contributions to a health FSA can’t exceed more than $2,750 annually. That amount might be lower depending on your employer.

Depending on the total cost of your cataract surgery, your FSA may not cover the full amount.

Health Savings Accounts (HSA)

An HSA is a tax-exempt account to help pay or reimburse qualified medical expenses. You must meet certain eligibility requirements for an HSA, including:

• Being enrolled in a high-deductible health plan (HDHP)
• Having no other health coverage, including Medicare
• No one claims you as a dependent on their tax return

For 2022, people on individual HDHP plans can contribute up to $3,650 to an HSA. Those on family plans can contribute up to $7,300.

Unlike an FSA, unspent money in an HSA rolls over at the end of the year. You may be able to save enough money to cover the full cost of cataract surgery over one or more years.

What Are the Out-of-Pocket Costs of Cataract Surgery?

Out-of-pocket expenses include costs that Medicare or private insurance plans don’t cover. Usually, they include procedures and products that aren’t considered medically necessary.

For example, monofocal IOLs are covered. This is because cataract surgery removes your natural lens, and a replacement is necessary. A monofocal IOL corrects your distance vision, but you may still need eyeglasses for reading.

You may hope to avoid the need for corrective lenses after surgery. Premium IOLs can provide clear vision up close and at a distance. However, the insurance provider will argue that eyeglasses are less expensive than premium IOLs.

In addition to multifocal IOLs, costs you should expect to pay include:

• Toric IOLs. These premium IOLs correct astigmatism. This makes it easier to see clearly at night while reading and doing other tasks without eyeglasses.
• Presbyopia-correcting IOLs. These advanced IOLs correct presbyopia, a common loss of up-close vision that occurs with age.
• Laser cataract surgery. This surgical procedure is more precise and more expensive than standard cataract surgery.
• Limbal relaxing incisions (LRI). Also known as corneal relaxing incisions, this additional procedure corrects astigmatism. Your surgeon can perform LRI during cataract surgery.
• Laser arcuate incisions. This procedure is similar to LRI but uses a laser instead of a hand-held surgical instrument.

Questions To Ask Your Healthcare Provider About Cataract Surgery

Policies vary widely from one insurance provider to the next.

Here are some questions you should ask your health care representative regarding cataract surgery:

• How much is my deductible?
• How much is my co-pay?
• Does my plan pay for prescription eyeglasses after surgery?
• Are you a “preferred provider” for any eye surgeons or surgical centers?
• If my eye surgeon is not a “preferred provider,” do I need approval before covering the procedure?
• Do you require advanced approval from a doctor to validate the medical necessity of my surgery?

• How Much Does Cataract Surgery Cost?
• What Impacts the Cost of Cataract Surgery?
• Does Medicare Cover Cataract Surgery?
• Does Private Health Insurance Cover Cataract Surgery?
• What Are the Out-of-Pocket Costs of Cataract Surgery?
• Questions To Ask Your Healthcare Provider About Cataract Surgery