What Does Medicare Cover for Cataract Surgery?

What does standard Medicare cataract coverage include?

Part B helps pay for removal of a medically significant cataract and implantation of a conventional intraocular lens, or IOL. The decision depends on your clinical circumstances and how cataracts affect activities such as reading or driving. An evaluation establishes the medical need and identifies other conditions that may limit vision.

Covered surgery can involve separate surgeon, facility and anesthesia charges. Coverage does not mean every charge is paid in full. Medicare also covers one pair of standard-frame eyeglasses or one set of contact lenses after each cataract surgery that implants an IOL, subject to its rules and cost sharing. Review Medicare’s cataract coverage.

Does the surgery setting affect your share of the cost?

Yes. Ambulatory surgery centers and hospital outpatient departments use different Medicare payment arrangements, so facility cost sharing can differ. A hospital outpatient copayment is not necessarily the same dollar amount as an ambulatory surgery center’s coinsurance. The surgeon’s services and other charges also contribute to the total.

Berg-Feinfield cataract surgery is performed at Pacific Surgery Center, an AAAHC-accredited ambulatory surgery center at 2829 W. Burbank Blvd., Burbank, CA 91505. Its phone number is (818) 567-0348. This surgical facility is separate from the Burbank consultation office on Alameda Avenue.

Use Medicare’s Procedure Price Lookup to compare national outpatient estimates. It is a planning tool, not your personal quote. Confirm the facility, surgeon and anesthesia arrangements before scheduling.

How do Medigap and Medicare Advantage affect costs?

Medigap supplements Original Medicare and may help pay covered deductibles, copayments or coinsurance according to the policy. It generally does not turn a noncovered premium-lens upgrade into a covered service. Plans sold to people newly eligible for Medicare on or after January 1, 2020 cannot cover the Part B deductible.

Medicare Advantage is a different way to receive Medicare benefits. Plan-specific copayments, networks and authorization rules apply; the Original Medicare 20% description is not a quote for every Advantage plan. Medigap does not pay Medicare Advantage cost sharing. Compare your plan documents with the proposed providers and services. Medicare & You explains these coverage choices.

What should your written estimate explain?

• The recommended procedure for each eye and a standard-lens option.
• Surgeon, facility and anesthesia estimates, with remaining deductible and cost sharing.
• Each optional lens or refractive service and its separate patient-paid amount.
• Who provides postoperative care and how any co-managed visits are billed.

Most Berg-Feinfield surgical patients see their own optometrist before and after surgery through co-management. Patients who are not co-managed use the in-house MD/OD team. Coordinate the clinical schedule and insurance details before committing to a plan.

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