Medicare and Eye Exams: Seeing the Coverage Clearly

Medicare pays for eye examinations for cataracts.

The question arises whether or not Medicare will pay for cataract surgery. The answer depends upon your age, health status, and other factors. If you are over 65 years old, then yes, Medicare may pay for cataract surgery if it is deemed medically necessary.

If you are under 18 years old, then no, Medicare won’t pay for cataract surgery. However, if you have a medical condition that requires cataract surgery (such as glaucoma), then Medicare will pay for the procedure.

What Does Medicare Pay For?

Medicare pays for all types of eye exams. Cataract surgery is one of them. Other common eye exams include:

Eyelid surgery (eyelids)

Lenses (lens replacement)

Refractive correction procedures such as LASIK (Lasik) and PRK (Prosthodontic Knee Surgery). These procedures require glasses or contact lenses. A refractive correction procedure involves changing the shape of your eyes so they better focus light into them.

Cataract surgery (cataracts)

Glaucoma treatment (Glaucoma)

Other common eye surgeries (ovarian cyst removal, etc.)

What Does Medicare Not Cover?

Medicare only pays for 80% of approved procedures and equipment. While your procedure may be covered by medicare, you might have to pay a portion of the bill. Below is a list of items that Medicare does not cover.

Contact Lenses

Eyeglasses and Sunglasses

Eye Makeup

Pregnancy Tests

What is Cataract Surgery?

A cataract is a clouding of the lens inside your eye. It’s a normal part of aging and can also be caused by eye trauma or diabetes. A cataract makes the world appear blurry. It can also cause other vision problems, such as:

Loss of Peripheral Vision

Tunnel Vision

Glare

Rainbows Around Lights

Flashing Lights

Blind Spots

As your cataracts get worse, you might only be able to see a small spot directly in front of you. Cataract surgery is the removal of the cloudy lens inside your eye. It’s often used to alleviate minor vision problems. It’s also known as cataract extraction.

During the procedure, your eye surgeon makes a small incision in your eye. He then uses instruments to remove the cataract and implant a new lens. After your cataract is removed, you’ll likely need to wear glasses or contacts. If you’re over the age of 50, your eye surgeon may recommend a new type of lens that helps people see distance and close-up.

Is Cataract Surgery Effective?

Cataract surgery is the most common operation in the United States. It’s very effective and one of the safest surgeries you can have. It can greatly improve your vision after a short period of recovery. Other benefits include:

You can wear glasses or contact lenses after cataract surgery.

You no longer have trouble finding your car in a parking lot or misplacing your keys.

Your independence is increased and you no longer rely on others to help you.

You can read smaller print and do other activities that were difficult before surgery.

If you’re considering cataract surgery, make sure to take care of yourself ahead of time. Eat a healthy diet and keep your blood pressure at a normal level. This will help ensure that you have a safe and successful procedure.

How do I get Medicare to Pay for My Cataract Surgery?

Medicare only covers cataract surgery in specific situations. It must be determined that your cataracts are causing moderate to severe vision problems. Your eye doctor will perform tests and screenings before and after your procedure. These exams determine if you qualify for Medicare coverage.

If you qualify, you’ll need to choose between 2 surgery options. You can either have your cataracts removed with an Intraocular Lens (IOL) replacement or a clear lens implant. Your eye doctor will help you decide which one is best for you.

How Much Does Cataract Surgery Cost?

On average, cataract surgery costs $2,000 – $4,000 out of pocket. This is because it doesn’t qualify for many in-network discounts and most major medical insurance policies don’t cover the procedure. While you may be able to find a low cost clinic to perform the procedure, make sure they’re using safe practices. The only way you’ll be able to have the procedure for free is if you have vision insurance. Be aware that many companies stop covering routine vision care at a certain age.

If you don’t have vision insurance and can’t find a low cost clinic, consider:

Purchasing an inexpensive pair of reading glasses for the time being. Using reading glasses won’t strain your eyes like relying on old cataracts.

Contact your local library or senior center to see if they have any free vision screening programs. Even if they don’t perform the surgery, they may be able to refer you to a clinic that does low cost exams and procedures.

Check with your local religious community for assistance. While this may be a long shot, many churches organize free or low-cost services in their community.

Check out the local medical school in your area. Qualified students can practice performing the procedure on live patients. If your cataracts are bad enough, you may be able to get some of your money back after the procedure.

You’ll find that most low cost or free programs offer other medical services in addition to cataract surgery. Some clinics offer additional screenings, check ups, and treatment services. While you don’t need them now, it’s good to know that you have access if something arises in the future.

While cataract surgery may not be covered by your current insurance, check into EyeMed. This affordable plan provides discounts on vision services and makes sure you can always get covered in-network care.

What if I can’t Afford Cataract Surgery?

If you’re worried about the cost of cataract surgery, consider asking your relatives or loved ones for assistance. Some seniors live with family members or dependents that can help pay for their medical services. Other seniors have a supportive spouse or children that want to help them out. If this is the case, see if they’re willing to help pay for the cost of surgery.

If you don’t have family members that can help, consider taking out a small loan. Your local bank may have competitive lending options for seniors, or offer loans specifically for medical procedures. These types of loans come with higher interest rates and have stricter payment terms than traditional loans.

Another option is to find a local credit union. These financial institutions are not-for-profit organizations with fewer fees and more lenient lending guidelines. While you may not qualify for the lowest interest loans, it’s worth looking into.

If you need an even smaller loan with more relaxed terms, consider a “payday” loan from your local store. Payday loans are small, short-term loans that you pay back in full with high interest when you get your next paycheck. Since these are high-interest loans, be careful not to over extend yourself and try to pay them back as quickly as possible.

Finally, you could always try to appeal to the kindness of a complete stranger. Many people offer free or low cost services to seniors on limited incomes. They may be able to suggest cheaper alternatives or perform the surgery completely free of charge.

You can find these generous individuals through online resources like Volunteer Match and Seniors 4 Help. These websites allow you to create a free profile and make contact with potential volunteers in your area. If you don’t want to use the internet, try reaching out to churches or community centers in your town. These local organizations often have free services or discounted medical programs for older people on a fixed income.

Whichever way you go about it, there are options to help you afford cataract surgery. With any luck, you’ll be able to regain your vision and live an even richer life!

Sources & references used in this article:

Lack of follow-up exams after failed school vision screenings: an investigation of contributing factors by LS Kimel – The Journal of School Nursing, 2006 – journals.sagepub.com

Visits to specialists under Medicare: socioeconomic advantage and access to care by J Blustein, LJ Weiss – Journal of Health Care for the Poor and …, 1998 – muse.jhu.edu

How Medicare could use comparative effectiveness research in deciding on new coverage and reimbursement by SD Pearson, PB Bach – Health Affairs, 2010 – healthaffairs.org

Thirty years of Medicare: impact on the covered population by ME Gornick, JL Warren, PW Eggers… – Health care financing …, 1996 – ncbi.nlm.nih.gov

Pathways to access: health insurance, the health care delivery system, and racial/ethnic disparities, 1996–1999 by SH Zuvekas, GS Taliaferro – Health affairs, 2003 – healthaffairs.org

Pre-enrollment reimbursement patterns of Medicare beneficiaries enrolled in “at-risk” HMOs by PW Eggers, R Prihoda – Health Care Financing Review, 1982 – ncbi.nlm.nih.gov

Association between vision loss and higher medical care costs in Medicare beneficiaries: costs are greater for those with progressive vision loss by JC Javitt, Z Zhou, RJ Willke – Ophthalmology, 2007 – Elsevier

Do health maintenance organizations work for Medicare? by RS Brown, DG Clement, JW Hill… – Health Care …, 1993 – ncbi.nlm.nih.gov

The extent of ownership and the characteristics of Medicare supplemental policies by T Rice, N McCall – Inquiry, 1985 – JSTOR