Cataract Surgery Cost
In the United States, most of the cost of cataract surgery typically is covered by Medicare (since most people who need cataract surgery are over age 65) or private medical insurance.
The amount insurance companies pay for the procedure, and the portion of the cost that must be paid directly by the patient (the "out-of-pocket" amount) can vary widely, depending on the deductible of the insurance policy, the type of intraocular lens (IOL) used for the procedure, and other factors.
In cases when a person does not have Medicare or private medical insurance, the patient is responsible for the entire cost of cataract surgery. In such situations, the cost of the procedure can vary widely, based on market conditions and the fee schedule the surgeon adopts for a no-insurance, direct-pay scenario.
In such cases, many surgeons charge the same price for cataract surgery as they charge for refractive lens exchange (RLE), which is an elective vision correction procedure that is nearly identical to cataract surgery. The difference between the two procedures is that, in RLE, the eye's natural lens is removed and replaced with an IOL before it has become cloudy with a cataract the exchange is performed exclusively to correct nearsightedness, farsightedness and/or astigmatism and thereby reduce the need for eyeglasses or contact lenses.
Cataract Surgery Cost 2015 Without Insurance
In 2015, the average cost of cataract surgery with a standard IOL performed in the United States for someone without Medicare or private health insurance was $3,542 per eye. (This estimate is from data from an annual survey of eye surgeons conducted by a leading vision care industry analyst, and assumes that the total fee for the procedure is identical to that charged for elective refractive lens exchange.)
But the cost of cataract surgery can increase significantly if you choose certain options.
For example, if you want a presbyopia-correcting IOL to reduce your need for reading glasses after surgery, the average added premium for this type of intraocular lens in 2015 was $2,178 per eye. And because this type of premium IOL is not considered medically necessary (see below), you typically will have to pay this additional fee out-of-pocket even if you have Medicare or private medical insurance.
What Are "Out-Of-Pocket" Costs For Cataract Surgery?
Fortunately, most people needing cataract surgery are covered at least in part by some kind of health insurance such as Medicare for those aspects of the procedure that are considered medically necessary.
For example, implanting a standard monofocal IOL during cataract surgery would be considered the standard of care and medically necessary. This is because your eye's natural lens is removed as part of a cataract procedure, and you need an artificial lens as a replacement to restore your sight.
You likely would have very good distance vision with this type of IOL, but usually you would need reading glasses for near vision. Also, if you had astigmatism prior to cataract surgery, you would still need prescription eyeglasses to correct astigmatism after surgery.
Today, many people who need cataract surgery want to be as free from glasses as possible after surgery. And thanks to advances in intraocular lens and surgical technology, it's now often possible to make this happen.
But this added technology comes with added costs, and in most cases Medicare and private medical insurance will not pay the added cost of these "premium" products and procedures. If you want many of the latest, high-tech advances in cataract surgery to reduce your need for glasses after surgery, you will have to pay the added cost of these products and services yourself ("out-of-pocket") even if you have insurance that covers the costs of standard cataract surgery.
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At first, this approach may seem unfair. But insurance providers argue that:
- Reading glasses are much less expensive than premium IOLs and easily can provide you with functional vision.
- Many people must pay for and wear eyeglasses that correct common refractive errors such as nearsightedness and farsightedness. Unless you have supplemental vision insurance, regular health insurance typically doesn't cover you for these kinds of vision problems.
- When people undergo refractive surgery such as LASIK to correct common vision errors, they also must pay full costs that typically aren't covered by insurance. Again, this is because surgical vision correction of this nature is considered cosmetic or medically unnecessary because you have the option of wearing much less expensive eyeglasses.
So while the costs of a basic cataract procedure and standard IOL usually are covered by Medicare and private medical insurance, you will need to pay the added cost of the following premium IOLs and advanced surgical techniques out-of-pocket if you want greater freedom from eyeglasses after cataract surgery:
Presbyopia-correcting IOLs. These advanced intraocular lenses expand your range of vision, reducing vision loss caused by presbyopia so you can read and see clearly up close without reading glasses. There are two types of presbyopia-correcting IOLs approved for cataract surgery in the United States: multifocal IOLs and accommodating IOLs.
In 2015, the average added premium for a presbyopia-correcting IOL was $2,178 per eye.
Toric IOLs. These astigmatism-correcting IOLs enable a person who had astigmatism prior to cataract surgery to see clearly for driving, computer use, reading and other tasks without eyeglasses after cataract surgery.
In 2015, the average premium for a toric IOL was $1,310 per eye.
Laser-assisted cataract surgery. In this advanced procedure (also called "laser catarct surgery"), a femtosecond laser is used to perform steps in cataract surgery that typically are performed with manual surgical tools, adding a higher degree of precision. Laser cataract surgery also can reduce stress on the retina and other delicate tissues of the eye during cataract extraction.
Laser cataract surgery usually is performed when a premium presbyopia-correcting or astigmatism-correcting IOL is implanted. The added cost of the laser procedure typically is included in the price of the premium IOL.
Limbal relaxing incisions. Also called LRI or corneal relaxing incisions, this is an additional surgical procedure that can be performed during cataract surgery to correct astigmatism. One or more small, arc-shaped incisions are made in the periphery of the cornea, and as these incisions heal (without stitches) the cornea takes on a more spherical shape.
In 2015, the average premium for LRI for astigmatism correction was $584 per eye.
Laser arcuate incisions. This minor surgical procedure is very similar to LRI, but the incisions are made with a femtosecond laser rather than a hand-held surgical tool.
In 2015, the average premium for laser arcuate incisions for astigmatism correction was $1,136 per eye.
|Standard Cataract Surgery (No Medicare or Insurance)||Out-Of-Pocket Premium For Presbyopia-Correcting IOL||Out-Of-Pocket Premium For Astigmatism-Correcting IOL|
|Percentage of Surgeons Charging in the Following Ranges:|
|More than $5,000||13.9%||0.8%||0.0%|
|$4,501 to $5,000||11.2%||0.0%||0.4%|
|$4,001 to $4,500||18.7%||3.7%||1.3%|
|$3,501 to $4,000||17.1%||5.0%||1.6%|
|$3,001 to $3,500||19.8%||14.3%||1.6%|
|$2,501 to $3,000||14.4%||34.0%||5.1%|
|$2,001 to $2,500||4.8%||23.3%||13.6%|
|$1,501 to $2,000||0.0%||7.4%||34.5%|
|$1,001 to $1,500||0.0%||11.4%||41.6%|
|$1,000 or less||0.0%||0.0%||0.2%|
|Medicare or private health insurance typically covers most or all expenses related to standard cataract surgery with a monofocal IOL. If you choose a premium intraocular lens such a presbyopia-correcting IOL or a toric (astigmatism-correcting) IOL or laser-assisted cataract surgery, you typically will pay the full premium for these advanced products and services out-of-pocket, whether or not you have Medicare or private insurance.|
This full-year 2015 pricing information was provided to AllAboutVision.com through special arrangement with a leading industry analyst. Typical charges by the majority of cataract surgeons surveyed are highlighted in yellow.
Standard Medicare And Health Insurance Coverage For Cataract Surgery
In uncomplicated procedures, Medicare coverage is very straightforward in terms of standard reimbursements paid to the eye surgeon and surgical center.
When it comes to cataract surgery, private health insurance providers tend to follow Medicare's lead regarding allowable charges that will be covered.
Reimbursements from private insurance can vary widely, depending on your responsibility for your copay and your annual deductible.
You may need to pay other related costs that aren't directly associated with the cataract procedure itself. For example, Medicare patients would need to pay 20 percent of these types of fees, which can include:
- An EKG to determine your heart health before you undergo a cataract procedure.
- A comprehensive eye exam, including precise measurements of your eye's refractive errors.
- Charges related to anesthesia personnel such as an anesthesiologist or nurse anesthetist.
- Standard prescription eyeglasses, if needed, to enhance near vision after you've had surgery.
- Any follow-up procedures or medical care due to cataract surgery complications outside a standard 90-day period designated for postoperative care.
As an example of a common complication, you might need to undergo a laser procedure (YAG laser capsulotomy) costing about $300 to correct posterior capsule opacification (PCO). This complication involves clouding of the residual membrane left in the eye at the time of cataract surgery, and upon which the IOL is placed.
Questions For Your Insurance Provider
You should speak in-depth with your insurance provider or Medicare representative before having cataract surgery, to understand exactly how much is covered and how much you ultimately may need to pay out-of-pocket. Terms of policies vary widely from one insurance company to the next. Questions to ask include:
- How much is the copay? In other words, would you be required to pay a certain amount such as 20 percent of all related costs, even though they are covered by your health insurance?
- How much is the deductible? Many people choose to have a relatively high annual deductible for their insurance coverage to keep monthly fees low. If you have an annual deductible of $1,000, for example, you will need to pay that amount out-of-pocket before proceeding with the cataract surgery if you haven't incurred other medical expenses that apply to the deductible.
- Does your plan pay for eyeglasses? If you need them following cataract surgery, find out if your coverage includes at least partial payment for a pair. Many insurance companies, including Medicare, offer a partial reimbursement for one pair of glasses in a lifetime after cataract surgery.
- Does your cataract surgeon have a special arrangement as a "preferred provider" or equivalent with your insurance company? This could make a big difference in the amount you are charged for standard cataract surgery, if you aren't already covered by Medicare. An eye surgeon with "preferred provider" or equivalent status must charge no more than standard rates for conventional cataract surgery, with agreed-upon maximums.
- If your eye surgeon is not "preferred," does your insurance company still need to approve him or her before covering the procedure?
- Is the surgical center a preferred provider or approved by your insurance carrier? It may not be, even if your surgeon is. It's essential that you have an understanding with your insurance provider or Medicare that the surgical center your surgeon will use is approved. Otherwise, you could (in a worst-case scenario) be responsible for all fees charged by the surgical center. And this could add up to several thousand dollars per eye.
- Does your insurance company require advance approval to validate that a cataract procedure is medically necessary? Some do.
[Page updated August 16, 2016]