Understanding the cost of cataract surgery can feel confusing, especially when insurance and Medicare are involved. In this video, Dr. Keith Skolnick, one of the cataract surgeons at the Fort Lauderdale Eye Institute, explains which parts of cataract surgery are covered by insurance, which services may involve additional costs, and why certain advanced options are not covered. This overview is designed to help you make informed decisions about your cataract care.
Hi, I’m Dr. Keith Skolnick. I’m one of the cataract surgeons at the Fort Lauderdale Eye Institute, and I’ve been asked to discuss the costs associated with cataract surgery.
Cataract surgery is a medically indicated procedure, and insurance companies and Medicare do cover many of the costs related to cataract surgery. However, there are certain costs they do not cover. The primary costs that are covered include anesthesia fees at the surgical center, as well as facility fees at the center.
Prior to cataract surgery, a series of tests and measurements are performed to help determine which type of lens implant will be placed in your eye to replace your cataract. Some of this testing is covered by insurance and Medicare, but some of it is not. We refer to the uncovered portion as advanced testing. This testing is considered necessary to achieve an excellent outcome with cataract surgery.
If a patient chooses a single-focus, monofocal, or standard lens implant, that lens is covered by Medicare and insurance companies. However, they do not cover the correction of astigmatism. Most patients have astigmatism, which refers to the shape of the eye. Instead of being perfectly round or spherical, the eye is shaped more elliptically or oval. Some insurance companies and Medicare consider astigmatism correction to be refractive, meaning it is not a covered service. As a result, there is an additional charge if astigmatism is corrected.
Similarly, if you would like presbyopia corrected, there is an additional cost. Presbyopia refers to the inability to focus up close. If you choose to have a multifocal or extended depth of focus lens implanted so that you can read without glasses, this is also not a covered service by Medicare or insurance. This is because it involves the correction of presbyopia.
In summary, correction of presbyopia, correction of astigmatism, and some of the advanced testing and measurements performed before surgery are not covered services. When we use a laser to perform cataract surgery—which we do in the majority of our cases—the laser itself is included as part of the procedure. However, insurance companies and Medicare do not pay for the use of lasers. When we are correcting astigmatism or presbyopia, we typically use a laser to assist with cataract surgery.
Thank you.
