A Clearer View

Latest treatment options and news about cataracts, dry eye syndrome and other eye care topics.

Is Cataract Surgery Covered by Insurance?

by Damion Wasylow 14 January 2020 04:27 AM

health insurance card on a table
Surgery is the only effective treatment for cataracts. To restore vision, the affected eye lens must be removed and replaced with an artificial lens called an intraocular lens implant (IOL). And surgery is the only way this can be done. With one in six people over age 40, and more than half of people over age 80 having cataracts, you will be relieved to know that, yes, cataract surgery is generally covered by insurance. At least, most of it. 

Medicare, Medicaid and most private insurance programs deem cataract surgery to be “medically necessary,” assuming the development of the cataract (or cataracts) is such that it interferes with the patient’s normal daily activities. Often, in the early stages of cataract development, your eye doctor will recommend against surgery until the daily impact is evident, and this generally aligns with insurance programs’ guidelines as well.

To be clear, when we talk about insurance covering cataract surgery, we’re referencing your general health insurance plan, not vision-specific insurance. Vision insurance plans are highly unlikely to cover any costs related to cataract surgery and are not required to under the Affordable Care Act.

Insurance plans generally cover the primary costs of cataract surgery, including:

  • Pre-operative eye scan
  • Traditional cataract surgical procedure
  • Monofocal intraocular lens implant
  • Any related medications

Depending on your plan, some diagnostic procedures and pre-surgery treatments may not be covered. Additionally, many premium intraocular lenses designed to also correct presbyopia or astigmatism are often not covered. Many patients opt to pay for these items out-of-pocket, as they can permanently eliminate the need for eyeglasses.

The specifics of health insurance plans vary, so it’s a good idea to talk with your health insurance provider in advance, so you know exactly what to expect.

If the time is right to restore your vision through cataract surgery, consider North Florida Cataract Specialists and Vision Care. Dr. Gregory Snodgrass and Dr. Matthew Gray, along with their talented medical team, are well-known for their experience, friendliness and results. And our helpful administrative staff will work with you and your insurance provider to ensure you get the coverage benefits to which you are entitled. 

Contact North Florida Cataract Specialists and Vision Care today at 352-373-4300.



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