Cataract Surgery Insurance Coverage Question

[Drake3287]

Have any of you come across this with aging parents or other elderly relatives? My elderly mother who's in her late 80's needs cataract surgery in both eye's and has both Medicare and the supplemental Kaiser Senior Advantage Plan. When she went to the required orientation class on the surgery (by herself unfortunately) they told her that insurance including Medicare doesn't cover this surgery and that each eye done will cost her $2,500. apiece, so $5,000. in total.

Of course at her age this is a huge cost but I can't believe this surgery isn't covered by Medicare. When Googling the question I find that yes, Medicare does cover this surgery on every site I find. Has anyone come across this issue with family members before?

Thanks

 

[REWahoo]

Something is getting lost in translation:

Medicare covers many medically necessary surgical procedures, like cataract surgery.

https://www.medicare.gov/coverage/cataract-surgery.html

See the note on that medicare.gov webpage.

Is there some sort of special lens implant involved that Medicare won't cover?

 

[MRG]

Something is getting lost in translation:



https://www.medicare.gov/coverage/cataract-surgery.html

See the note on that medicare.gov webpage.

Is there some sort of special lens implant involved that Medicare won't cover?

+1
ACA insurance follows Medicare guidelines regarding cataracts. I paid for premium lens but otherwise my copay was about 50 bucks IIRC.

 

[braumeister]

Medicare won't cover special lenses, but it will cover all the related surgery costs.

In my case, with normal cataract lens implants, everything was covered.

In DW's case, she had severe astigmatism and needed toric lenses, which were not covered. They were $1,600 each out of pocket. Sounds like your mom has a similar situation. Why not just call the doctor's office and ask?

 

[Teacher Terry]

Your eyes have to be bad enough for Medicare to cover the surgery. I have 2 friends whose eyes are pretty bad but they won't pay until their eyes get worse.

 

[W2R]

In my case, with normal cataract lens implants, everything was covered.

Same here - - everything except for the eyedrops, for which I paid $71.25/eye.

My suggestion is that someone should accompany her and look into this to find out what is going on.

 

[Winemaker]

Most insurance companies including Medicare cover "normal" cataract surgery. It is when you get the "laser" version, that it is not covered. DW had the laser version done in Nov/Dec and it cost $2500/eye.

 

[friar1610]

I had both eyes done under Medicare. It is true that your eyes have to get to a certain level of "bad" but the ophthalmologists will know what this level is. It is also true that Medicare will only cover a single type lens - either distance or reading - not the "bifocal" type.

Re: the "bifocal" lenses, the ophthalmology clinic at the hospital where I had mine done would not do them. (This was as of about 6 years ago.) The said there were too many follow-on problems with them. My doc told me they did a nice business replacing bifocal lenses (with single lenses) for people who could no longer stand their bifocals.