Harriet Edlson
You are not alone. By the age of 80, more than half of all Americans have cataracts or have undergone cataract surgery.
If your eye doctor tells you that you have cataracts in one or both eyes and suggests surgery to remove them, don’t despair.
If you don’t see as well as you used to, one of the reasons could be that you have developed cataracts in one or both eyes. A cataract is a clouding of the natural lens of the eye. Cataract surgery removes the cloudy lens, and the lens can be replaced with different types of lenses during surgery. According to the National Eye Institute, by age 80, more than half of all Americans have cataracts or have undergone cataract surgery.
If cataracts are interfering with your daily activities (driving, reading, working on a desktop or laptop computer, needle sticks, playing sports, etc.), it may be time to consider cataract surgery.
A decision about cataract surgery begins with an examination and a conversation with your doctor. After that, “it’s a personal decision,” says Vicente Diaz, assistant professor of clinical ophthalmology at Yale University School of Medicine and chief ophthalmologist at Bridgeport Hospital.
Ophthalmologists remind patients that cataract surgery, although a common procedure, is considered elective, a decision that each individual must make. Sure, your eye doctor can guide you when the best time is to have your cataracts removed.
“Talk with your doctor about what your life is like, how you spend your time, how active you are, and what is important to you. increase”.
Removing the cataract and inserting a new lens restores or improves vision.
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If you are debating whether or not to have cataract surgery, consider additional benefits. A study published in JAMA Internal Medicine in December showed that cataract surgery lowered her risk of developing dementia in adults over the age of 65 by about 30%. , 2021 paper “Relationship between cataract removal and development of dementia”.
What costs does Medicare cover?
According to the Centers for Medicare and Medicaid Services, Original Medicare covers 80% of the approved cost of cataract surgery completed by a doctor using conventional surgical techniques or lasers. Patients pay the remaining 20% once the Medicare deductible ($226 for Part B) is met. Specifically, the original Medicare covers procedures used to remove cataracts that doctors consider medically necessary, and doctors needed to insert a conventional intraocular lens (IOL) during cataract surgery. Pay for services and supplies, as well as post-surgery physician services and related care.
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Additionally, according to the Centers for Medicare and Medicaid, your original Medicare will cover the cost of a pair of glasses after each cataract surgery involving the insertion of a conventional IOL, also known as a conventional monofocal IOL.
Keep in mind that the type of lens recommended for your eye can affect the cost of surgery and how much Medicare or other insurance will cover. Includes lenses, multifocal lenses, monovision with one eye set for near vision and one eye set for distance vision, self-tinting lenses, toric lenses, and extended depth of focus lenses . With the exception of single vision lenses, most other lenses are not covered by your original Medicare or other insurance. If an imaging test is required to insert a lens other than a single vision lens, Medicare will not pay for it.
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Where the procedure takes place determines how Medicare will pay for it. Original Medicare pays the fees and charges of operating centers and other facilities, or the cost of procedures in the clinic, by one portion of the Physician Fee Schedule (PFS), which represents the cost of using both clinic space and physician work. cover
When surgery is performed in a hospital’s outpatient department, 80% is paid in two parts under the Outpatient Scheduled Payment System (OPPS), and doctors are paid separately under the PFS, according to the Centers for Medicare and Medicaid. increase. Patients pay the remaining 20%. Or, if you have other insurance, such as an additional Medicare plan or a Gap plan, it may be paid by that insurance company. If you have a Medicare Advantage Plan, check with your insurance company before scheduling surgery to determine what will be covered and what will be out of pocket.
Medicare pays for conventional or single vision lenses as part of the facility fee.
According to Yvonne Wang, an ophthalmologist at Yale School of Medicine who specializes in cataract and corneal surgery, monofocal lenses are covered, in which a surgeon inserts two monofocal lenses of different powers. includes vision. “However, multifocal, photochromic and toric lenses are not covered and must be paid by the payer out of pocket. The cost of these lenses is set by the university or clinic,” she said.
However, according to the Center for Medicare and Medicaid, “Medicare coverage and payments for cataract surgery depend on whether the surgery is performed using conventional surgical techniques or using a bladeless, computer-controlled laser. It’s the same regardless: Either way, Medicare covers the cost of removing the cataract and inserting a conventional intraocular lens, also called a monofocal lens.
The total cost of cataract surgery depends on the type of insurance you have. “In some cases, you may need to obtain prior permission from private insurance companies.”
She advises patients to contact their insurance companies. Check before scheduling surgery. Be careful, especially if out-of-pocket costs are an important consideration.
– Harriet Eddleson
(Closed) Dow Jones Newswire
01-31-23 0535ET
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