Cataract Surgery and Insurance Coverage: What You Need to Know

Cataracts are a common progressive eye condition that mostly occurs naturally with age. Approximately half of all Americans have cataracts by the age of 75. Proteins in the lens break down and create a cluster, which clouds the lens and causes blurry, hazy, or less colorful vision. People with cataracts may also experience increased sensitivity to light, a halo effect around light fixtures, or difficulty seeing at night. Over time, cataracts can cause vision loss. 

Correcting Cataracts With Cataract Surgery

Fortunately, cataracts can be corrected with cataract surgery. More than 3.5 million cataract surgeries are performed each year in the U.S. The surgery removes the lens of the eye and replaces it with an artificial lens, called an intraocular lens (IOL), made from acrylic, silicone, or plastic.

Our team of expert surgeons at Swagel Wootton Eye Institute performs both traditional and laser cataract surgery. Traditional surgery involves a surgeon making a small incision in your cornea. For our laser surgeries, we use state-of-the-art laser technology to ensure patients experience minimal discomfort and enjoy the best possible results. A computer-assisted instrument allows us to make precise, customized cuts. An intraoperative aberrometer tool is used after the cataract is removed to improve the outcome. Our cataract self-test can help you decide if it may be time for a cataract surgery evaluation.

Does Insurance Cover Cataract Surgery? 

Cataract surgery is typically covered, at least in part, by health insurance plans, including Medicare, Medicaid, and private plans (such as Affordable Care Act-compliant plans found on a health insurance marketplace). 

Surgery typically must be deemed “medically necessary” in order to be covered by insurance. This means vision acuity has reached a certain threshold and the cataracts are interfering with daily activities. Coverage varies by plan, and deductibles and copays often apply.

For example, Medicare Part B (the medical insurance part of Original Medicare), covers 80% of Medicare-approved costs for medically necessary cataract surgery after the Part B deductible is met. That means you will be responsible for 20% of the cost. Medicare supplement plans may help cover those costs. The surgery must be performed using traditional techniques or laser cataract surgery in order for it to be covered. Medicare Advantage plans purchased through private insurance companies may also cover cataract surgery. Those costs depend on the plan, and you may be responsible for a copay or coinsurance. 

Some plans may not cover all services related to cataract surgery, such as diagnostic exams and pre-surgery treatments. Additionally, many premium IOLs are not covered by insurance and require an out-of-pocket cost. Always speak to your insurance provider prior to your surgery to understand your plan benefits and out-of-pocket payment responsibilities. 

It’s also important to note that cataract surgery is typically covered under health insurance plans versus vision insurance plans, which are unlikely to cover any portion of the procedure. 

Affordable Payment Options for the Vision You Deserve

At Swagel Wootton Eye Institute, we’re here to help you manage cataract surgery costs so you can enjoy life to its fullest. We’re proud to accept most insurance providers in Arizona, and our patient care team is always happy to confirm if we accept your insurance. 

If you do not have insurance, or if your plan does not cover cataract surgery, our team of knowledgeable professionals can help you explore other payment options: 

• Financing: We offer flexible payment plans and interest-free financing through Alphaeon Credit and CareCredit. You may qualify for 0% interest for up to 24 months with no money down with approved credit, as well as extended payment options up to five years. Your surgical counselor can help answer any question and assist you with completing the application process at your consultation.
• Health savings accounts (HSAs) and flexible spending accounts (FSAs): With these types of accounts, you can use pretax dollars to pay for medical expenses not typically covered by insurance — including cataract surgery. You can use these funds to cover all or part of your procedure.

Learn More About Cataract Surgery From Swagel Wootton Eye Institute

If you’re ready to see more clearly with cataract surgery, we’re ready to see you through on your journey. Our surgeons have decades of combined experience and have helped thousands of patients improve their quality of life. Request an appointment today.