Cataract Surgery Cost
The cost of cataract surgery depends on many variables, such as the type of procedure you have and the intraocular lens (IOL) implanted in your eye. The area where you live also can be a factor, depending on cost-of-living standards that help set the typical price of cataract surgery.
On average, straightforward cataract surgery in the United States would cost you about $3,230 per eye if you paid for everything yourself, according to a report of full-year 2013 fees commissioned by AllAboutVision.com from a leading industry analyst. (In 2010 the average was about $3,279, in 2011 it was $2,699 and in 2012 it was $3,429.)
If you want a high-tech, presbyopia-correcting intraocular lens for your cataract procedure, then costs would increase to an average of about $4,350 per eye (vs. $4,461 in 2010, $4,337 in 2011 and $4,269 in 2012).
What Are Your Real 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.
A presbyopia-correcting IOL, on the other hand, potentially can provide vision at multiple distances and free you of eyeglasses altogether. As a result, Medicare and many insurance providers consider the implantation of this type of high-tech, "premium" lens as medically unnecessary.
Therefore, any extra costs directly associated with this more expensive type of lens must be paid for out-of-pocket.
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At first, this approach seems a little illogical. 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 would be covered by an insurance provider, you would need to pay out-of-pocket for any extra expense associated with a premium or presbyopia-correcting lens that may help perfect your vision.
|Range||RLE or cataract surgery with PC-IOL (no Medicare or insurance)||RLE or cataract surgery with monofocal IOL (no Medicare or insurance)||Premium for PC-IOL cataract patient with Medicare||Premium for toric IOL cataract patient with Medicare||LRI, CRI or other incisional procedure to correct astigmatism|
|Percentage of Surgeons Charging in the Following Ranges:|
|$1,000 or less||0%||0%||7%||53%||90%|
|$1,001 to $1,500||0%||0%||8%||35%||6%|
|$1,501 to $2,000||5%||14%||33%||7%||2%|
|$2,001 to $2,500||7%||20%||37%||4%||1%|
|$2,501 to $3,000||7%||24%||8%||0%||0%|
|$3,001 to $3,500||7%||18%||5%||1%||0%|
|$3,501 to $4,000||10%||6%||1%||0%||0%|
|$4,001 to $4,500||19%||10%||0%||0%||0%|
|$4,501 to $5,000||19%||4%||0%||0%||0%|
|More than $5,000||26%||6%||0%||0%||0%|
|These prices for cataract surgery or refractive lens exchange (RLE) include people not covered by Medicare or private health insurance. With insurance coverage, you can expect to pay extra or "premium" costs out-of-pocket for presbyopia-correcting (PC-IOLs) and for astigmatism-correcting (toric) IOLs. A premium also is charged if you need an astigmatism-correcting procedure, such as limbal relaxing incisions (LRIs) or corneal relaxing incisions (CRIs).|
This full-year 2013 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. Figures are rounded to nearest whole number.
Extra Costs of Premium IOLs in Cataract Surgery
Because insertion of a presbyopia-correcting IOL is an elective procedure, eye surgeons have no set of rules or restrictions governing what they can charge you for extra fees. These fees can be highly variable.
If you choose this option, make sure you ask ahead of time for an accounting of all separate charges associated with a premium IOL, including what specialized tests might cost. This way, you will know exactly what you will be asked to pay for out-of-pocket.
According to the AllAboutVision.com special report on cataract surgery costs, the potential extra charges that you may need to pay out-of-pocket if you choose a presbyopia-correcting IOL include:
- An average additional charge of $2,115 per eye for a premium, presbyopia-correcting IOL, if you already have Medicare coverage for basic cataract surgery costs.
- An average additional charge of $529 per eye, if you need an extra surgical procedure to correct mild astigmatism.
Premium IOLs don't provide crisp vision if you have a certain amount of lingering, uncorrected astigmatism.
So as part of cataract surgery involving a premium IOL, you may need limbal relaxing incisions (LRIs) or corneal relaxing incisions (CRIs) to eliminate astigmatism. These procedures involve making superficial cuts in your cornea to flatten it slightly, which can eliminate or greatly reduce the astigmatism.
Again, Medicare and most private insurance will not cover the cost of a procedure for eliminating astigmatism. If you have astigmatism and need LRIs or CRIs, this is another potential out-of-pocket cost of premium cataract surgery.
As a general guideline and even if you have insurance coverage, you could end up paying around $2,600 extra per eye or more if you choose a presbyopia-correcting IOL and also need astigmatism correction.
But the upside of a premium IOL is that you potentially could be less dependent on eyeglasses or free of them altogether.
Even if you don't want presbyopia-correcting IOLs, you might choose cataract surgery with a "premium" astigmatism-correcting artificial lens, called a toric IOL.
This type of lens could be ideal for someone with an irregularly shaped cornea that causes significant astigmatism. Once a toric IOL is "fixed" inside the eye, it easily can offset vision problems caused by an irregularly shaped eye surface by intercepting and refracting light rays into a sharper point of focus.
However, Medicare and private insurance typically would not consider a toric IOL for astigmatism medically necessary. So if you opt for this kind of lens and otherwise have insurance, the average extra cost to you would be about $1,115 per eye.
When you ask your eye surgeon's billing representative about the costs of a premium IOL (presbyopia-correcting or toric for astigmatism), make sure you clarify these points:
- Are you being charged extra for any aspect of the basic surgery itself, even though you have Medicare or private insurance coverage? This is important to know, because Medicare will not allow "double" charging for basic surgery costs already covered even if you do choose a premium IOL.
- Medicare and private insurance reimbursements typically cover certain preliminary and postoperative surgery costs, such as basic eye exams and testing, which should not be billed again to you personally if you have coverage.
Be sure to ask your eye surgeon's billing representative for a detailed breakdown of charges so that you better understand specific services and their related costs.
You have a right to see precisely what you need to pay out-of-pocket for those aspects of a premium IOL procedure that will be billed directly to you.
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.
Cost of Refractive Lens Exchange
In a refractive lens exchange (RLE), a person chooses to have a natural lens that does not yet have a cataract replaced with an IOL for vision correction. The surgical procedure and related costs are virtually identical to cataract surgery.
Like LASIK, a refractive lens exchange (also known as clear lens extraction) is an elective procedure usually performed to make a person less dependent on eyeglasses. If a presbyopia-correcting IOL is used, eyeglasses may not be needed at all.
A person with early signs of cataracts may want an RLE instead of LASIK for vision correction, because future cataract surgery may be inevitable anyway.
But unlike most patients undergoing cataract surgery, a person who chooses an RLE must pay all costs out-of-pocket because the procedure is not medically necessary.
This can be an expensive proposition, especially when you are looking at average out-of-pocket costs of about $4,350 per eye for an elective procedure involving higher priced presbyopia-correcting IOLs.
In negotiations with the cataract surgeon who performs the RLE, you might consider asking for price breaks. For example, try requesting that you be charged the same basic standard surgical fees paid by regular cataract patients covered by Medicare or private insurance.
You still will need to pay the "premium" price for presbyopia-correcting IOLs, but you could save some money when it comes to standard surgical costs.
[Page updated December 18, 2014]
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