Cataract surgery cost

[lucky penny]

My doctor recommended cataract surgery in one eye & gave me the names of 3 doctors he recommends for it. It's been my impression that Medicare pays most of the cost (80%) & the patient's supplemental insurance usually covers the rest. Has this been your experience? And can anyone tell me the total cost billed for the procedure BEFORE insurance pays?

Medicare is my primary insurance & my supplemental coverage is a plan for retired state employees which so far has covered almost all my medical bills, but I've never had a procedure like this.

One of the recommended doctors is a participating provider in my plan's network so if I use him I expect the cost to me will be minimal. The other 2 are not in my plan, so if I use either for the surgery my plan will pay some of the additional cost & I'll be responsible for the rest. (I need to call my insurance again to find out what % they'll cover -- I can't remember what they told me.)

The doctor in my plan is not nearby & it will be a long trek to his office (in the Bronx), especially for multiple follow-up visits. His staff was nice on the phone but not very polished. The other 2 doctors are nearby (very convenient) & seem to be top of the line in every way. A friend recently had cataract surgery with one of them & was highly satisfied with every aspect of the experience -- that's what I want too!

I'm definitely willing to pay part of the cost but would like a sense of what that might be & whether most people who have the surgery do this. What was your experience?

 

[Ian S]

Medicare with supplement covers the cost of the surgery and the cost of a standard lens. They do not cover the cost of any of the various more sophisticated corrective lenses. I opted for toric lenses to correct my astigmatism. They were about $1500 each.

 

[CyclingInvestor]

Just had cataract surgery on both eyes. Medicare and supplemental paid everything. I did not add on any options.

I went from 20/70 and 20/200 to 20/20 and 20/30. No new lenses until after retinal surgery shortly.

 

[Teacher Terry]

I didn’t pay a dime with Medicare and a supplement plan. I got standard lenses because I couldn’t imagine having one eye for distance and one for reading. I felt it was too big a decision that could be wrong for me.

 

[target2019]

Here's my recent thread on cataract surgery. https://www.early-retirement.org/forums/f38/the-summer-of-2023-freedom-from-cataracts-118326.html

Lots of people chimed in with their experiences, costs, etc.

With Medicare and Plan G I paid nothing (that I can recall). I was not a candidate for any alternative lenses.

There are other recent threads on cataract surgery too.

 

[Buckeye]

I find it interesting you say you have Medicare with a supplement plan but you also have a provider network. Normally, traditional Medicare with a supplement doesn't have a provider network. Sound more like a Medicare Advantage plan but then I don't understand having a supplement policy. Just curious.

 

[Sue J]

DH and I both had this done last year.

For EACH EYE Medicare was billed -

From the Eye Clinic - Billed $2400. Medicare approved $1010. Medicare paid $792. Medicare supplement paid $202. ($18 difference in there, don't know why. This is from the EOB)

From the eye surgeon - Billed $1500. Medicare approved $519. Medicare paid $407. Medicare supplement paid $104.

Anesthesia - Billed $600. Medicare approved $94. Medicare paid $74. Medicare supplement paid $19.

Follow-up exams were included in the price. This included a post-op refraction which Medicare usually doesn't cover when it's not post-op.

In addition to these costs billed to Medicare we chose upgraded intraocular lenses. Those were between $1799-$2799 PER EYE. This was paid out of pocket on the day of the surgery.

There are a lot of visits involved in this so take that into consideration when choosing which clinic and how far it is.

2023 was a Blow That Dough year for us! Well worth it

 

[lucky penny]

DH and I both had this done last year.

For EACH EYE Medicare was billed -

From the Eye Clinic - Billed $2400. Medicare approved $1010. Medicare paid $792. Medicare supplement paid $202. ($18 difference in there, don't know why. This is from the EOB)

From the eye surgeon - Billed $1500. Medicare approved $519. Medicare paid $407. Medicare supplement paid $104.

Anesthesia - Billed $600. Medicare approved $94. Medicare paid $74. Medicare supplement paid $19.

Follow-up exams were included in the price. This included a post-op refraction which Medicare usually doesn't cover when it's not post-op.

In addition to these costs billed to Medicare we chose upgraded intraocular lenses. Those were between $1799-$2799 PER EYE. This was paid out of pocket on the day of the surgery.

There are a lot of visits involved in this so take that into consideration when choosing which clinic and how far it is.

2023 was a Blow That Dough year for us! Well worth it

Thanks so much Sue & all who responded. This is great information, just what I was looking for. I'll also read the earlier thread that was mentioned.

Looks like I may have to decide whether to Blow That Dough with one of the "Cadillac" doctors (I'm tempted!), go to the Bronx doctor who will cost me nothing (hmm, also tempting), or look for another surgeon who's recommended & takes my supplemental insurance.

 

[Sue J]

Are you sure you have a supplement? Or is it a Medicare Advantage Plan?

With Original Medicare and a Medicare Supplement there are no networks. If your doctor accepts Medicare then your supplement will pay their portion.

If you have a Medicare Advantage plan then your doctor needs to accept your plan.

 

[lucky penny]

I find it interesting you say you have Medicare with a supplement plan but you also have a provider network. Normally, traditional Medicare with a supplement doesn't have a provider network. Sound more like a Medicare Advantage plan but then I don't understand having a supplement policy. Just curious.

My supplemental plan as a state retiree is very similar to the coverage I had when I was employed except that Medicare is now my primary insurance. After Medicare has paid, if the doctor is in the provider network there's no charge or a small-payment; for someone outside the network, 80% of the amount is covered.

 

[lucky penny]

Are you sure you have a supplement? Or is it a Medicare Advantage Plan?

With Original Medicare and a Medicare Supplement there are no networks. If your doctor accepts Medicare then your supplement will pay their portion.

If you have a Medicare Advantage plan then your doctor needs to accept your plan.

To answer your question, I just called the plan & asked. They told me it's not a Medicare Plan, not a Medicare Advantage Plan, but "a commercial PPO plan". Very similar to the coverage I had as a state employee (UnitedHealthcare/Empire Plan) except that Medicare is now my primary.

Edit to add: I've been calling it a supplemental plan but a better term might be my secondary insurance.

 

[CRLLS]

My recent (2-3 months back) cataract surgery and all the bills were covered 100% by Medicare & my Plan G supplement. The coverage included a basic mono-focal lens. I opted for laser astigmatism correction in the first eye for an additional out of pocket charge of $1,200. The 2nd eye was a bit different as my astigmatism was a bit higher, on the border between choosing between laser and Toric lens. The Dr suggested a Toric lens. I was charged the same $1,200, again out-of-pocket. Surprise to me, that 3 days ago I received a $395 check in the mail from my dr's office. I called to ask what it was for and they told me it was for overpayment on the Toric lens. From what I can discern, Medicare also covers some amount for your first pair of glasses after cataract surgery. I don't know that for certain. I just bought a pair of readers from Amazon now. I paid $10 total for the two readers. maybe I'll order progressive glasses from Zenni after a few months more. At the moment, I am loving seeing the wide field of vision crisp and clear without glasses that I have needed for about 60 years.

 

[zl55lz]

Thanks so much Sue & all who responded. This is great information, just what I was looking for. I'll also read the earlier thread that was mentioned.

Looks like I may have to decide whether to Blow That Dough with one of the "Cadillac" doctors (I'm tempted!), go to the Bronx doctor who will cost me nothing (hmm, also tempting), or look for another surgeon who's recommended & takes my supplemental insurance.

I think the charges will vary by location. My spouse had both eyes done (first one eye then the other 2 weeks later), standard lens implants:

Outpatient facility charges EACH time were approx $13,900.00 (not a typo); Medicare as primary paid about $1994.00 each time; secondary insurance paid approx $498.00 each time.

Dr. charges were $2596.00 each time, Medicare paid approx $457.00 and secondary approx $113.00 each time.

The anesthesiologist and subsequent dr bills were fairly small, and there were a few followup visits.

Between Medicare and secondary insurance (FEHB) everything was covered 100%. The allowed amount of course, not the amount requested by the provider!!!

 

[KCGeezer]

Perfectly timed thread. I just got back from the measurement and lens discussion/decision appointment for my upcoming cataract surgery.

I’m going with the basic monofocal with laser correction too. $1700 per. All else will be covered by Medicare and supplemental plan.

I’ll be interested in how your experience goes lucky penny.

 

[lucky penny]

Hi Geezer -- Glad to give an update after my surgery last March.

I'm very happy with my experience, both the process & the results. I chose one of the "Cadillac doctors" (highly recommended by a friend who does everything first-class, but since the doctor doesn't take my secondary coverage the cost was uncertain). My initial visit for a consultation, which I thought would be mostly discussion, turned out to be at least 90 minutes of exams before I saw the doctor. Spoke with him, whom I liked a lot. Asked about the cost (which I'd previously discussed with his staff by phone), & he assured me everything would be covered by Medicare except for a Toric lens ($1,700) to correct for astigmatism. (Medicare only covers a standard lens.) Monofocal, which he recommended.

He said most people don't need laser surgery for cataracts but it was possible he would need to do laser surgery afterwards to "clean up" since the cataract was oddly placed. He said that would be a simple process in his office (but it was never needed).

So, at that visit, I scheduled the surgery, paid half the $1,700 in advance (paid the other half on the day of surgery), & cancelled a consultation with another doctor.

I was anxious about the final cost until the post-surgery bill arrived -- & the doctor wasn't quite right: 2 pages of itemized charges totaling around $10,000, & I owed $90. Happy to pay that for first-class treatment & thank goodness for Medicare!

I saw the doctor for check-ups a day after surgery (when he removed the eye patch), a week later, & 2 weeks after that. All was well, & my vision improved immediately & dramatically. As others have said, there is a routine of eye drops before the surgery & for 3 weeks afterwards which must be followed diligently.

I will see the doctor next month to check both my post-surgery eye & the other eye, which he said will likely need surgery at some point. My vision seems fine but I think my regular ophthalmologist waited too long to recommend the last surgery; by the time I had it, the vision in that eye had really deteriorated.

This was my first surgery & I'd had little experience with hospitals & what to expect, but everything about the doctor, his staff & the entire experience was reassuring. A+++ for competence, skills, courtesy, providing information, trustworthiness. Fingers crossed that future experiences will be this positive.

PS about anesthesia: In the pre-surgery discussions I heard about "local anesthesia," but didn't really think about what that meant; I assumed I'd be totally unconscious (like for a colonoscopy) because how can you be conscious when they're operating on your eye? So I remember closing my eyes & waiting for the anesthesia to kick in, & it took me a long time to realize the procedure had actually started so my eye must be open. But I never felt anything, saw only darkness, still felt my eyes were closed (& had no desire to open them); I heard muffled voices & sounds, wiggled my fingers & toes to confirm I was partly conscious, but was totally relaxed the entire time & fine with everything. Very odd experience!

 

[RetMD21]

....

PS about anesthesia: In the pre-surgery discussions I heard about "local anesthesia," but didn't really think about what that meant; I assumed I'd be totally unconscious (like for a colonoscopy) because how can you be conscious when they're operating on your eye? So I remember closing my eyes & waiting for the anesthesia to kick in, & it took me a long time to realize the procedure had actually started so my eye must be open. But I never felt anything, saw only darkness, still felt my eyes were closed (& had no desire to open them); I heard muffled voices & sounds, wiggled my fingers & toes to confirm I was partly conscious, but was totally relaxed the entire time & fine with everything. Very odd experience!

For me it was strange that they were doing surgery on my eye but I didn't care.

 

[Turbo29]

They gave me the anesthetic cocktail and while I was awake, I was pretty relaxed. I was conscious of light and I could tell the exact moment when they pulverized the old lens in my eye. At that moment I thought, "I guess it's too late to back out now." I wasn't concerned, it was just a matter of fact observation.

 

[Buckeye]

DH just had cataract surgery in both eyes, 3 weeks apart. His 20% payment for the actual surgery was $238.16 per eye. This was for the standard lens. He has a G HD supplement so this was his cost. We're fine with the cost since he's saving about $150 a month versus his old Plan N supplement. After his Part B deductible was met, the eye doctor office visits were about $20 which is no extra cost on the G HD supplement because he was responsible for the first $20 on Plan N. The surgery went well and there's only 8 days of drops left. He can't put drops in his eyes so I've had to do all of them. I'm done!