How Much Does Cataract Surgery Cost?
The average out-of-pocket cost of cataract surgery is $3,500 per eye, based on the most recent estimates. This reflects a standard cataract surgery procedure that is not covered by private insurance or Medicare, both of which would offset the out-of-pocket expense.
The vast majority of people in the U.S. who get cataracts are over 65 years old and are therefore covered under Medicare. Those who aren’t eligible for Medicare, but still require surgery, typically have some sort of private insurance coverage, the extent of which varies from plan to plan.
The cost of surgery can also be influenced by which technologies and techniques are used. Laser cataract surgery is becoming a popular alternative to traditional cataract surgery, and it can cost upwards of $1,000 per eye, in addition to the base fee.
The type of IOL chosen also influences the cost. There are two basic categories of premium IOLs: toric IOLs to correct astigmatism and refractive IOLs (Crystalens, ReSTOR, ReZoom, Tecnis) to correct presbyopia. The additional cost of cataract surgery with toric IOLs is approximately $1,300. Refractive IOLs are even more expensive, with an average cost of $2,100. So if you elect to have cataract surgery with premium refractive IOLs, your on-paper cost could be in the $5,600 range.
These high-tech lenses are different than the standard monofocal IOL used in basic cataract surgery, which corrects vision for only one distance, and does not correct astigmatism.
What Factors Impact Cost?
Although cost estimates can give you a sense of cataract surgery pricing, your exact cost may differ substantially based on a variety of factors, including:
- The part of the country where the surgery is performed
- Whether the surgery is conducted in an out-patient surgery center or hospital
- The skill, reputation and experience of the surgeon
- The type of IOL you select
- Whether or not a laser is used
- Pre- and post-op visits
- Post-op medications
These factors can impact the on-paper cost of cataract surgery, but the biggest factor impacting your true cost is the type of insurance coverage you have.
Private Insurance Coverage & Medicare
Since cataract surgery is considered a medically necessary procedure, the cost of cataract surgery is largely covered by private insurance or Medicare, the latter of which covers most patients. Medicare is the U.S. federal health insurance program that covers people aged 65 and older. Although Medicare Part A is free for most people, Part B has a monthly premium (typically $100 – $135).
Cataract surgery is typically an out-patient procedure, meaning that you have the surgery in a hospital or doctor’s office, then go home the same day. As such, it falls under Medicare Part B (which covers outpatient treatment and doctors’ services). Though Medicare and private insurance generally cover standard cataract surgery with monofocal implants, they do not cover the additional cost of refractive cataract surgery, which includes a premium IOL and/or a laser. Medicare covers approximately 80% of the cost associated with standard cataract surgery, leaving the patient responsible for the remaining 20% after the deductible is met (the 2017 deductible for Medicare Part B is $183). To provide an example of what the cost breakdown might be for someone getting standard cataract surgery covered by Medicare, consult the table below:
|Standard Cataract Surgery||Medicare Coverage||Out-of-Pocket||Deductible||Total Cost to Patient|
For standard cataract surgery, Medicare covers:
- The removal of the cataract
- Basic (monofocal) lens implants
- One set of prescription eyeglasses or one set of contact lenses after the surgery
If premium IOLs are desired to correct refractive errors and eliminate dependence on glasses and contacts, then the patient will have to cover the difference. For example, if the patient referenced in the above cost breakdown wanted to have surgery with a premium toric IOL to correct astigmatism, he or she would be responsible for the $883 + $1,300 ($2,183), the average cost of a toric IOL. If the patient referenced above opted for a presbyopia-correcting premium IOL, the cost would be $883 + $2,100 ($2,983). If the patient also wanted laser cataract surgery, then add on another $1,000. Essentially, premium cataract surgery can nearly double or triple the potential out-of-pocket costs.
Closing the Gap with Medigap
If premium cataract surgery is desired but there is a concern about the out-of-pocket costs not covered by Medicare, then there is the option to buy a separate “Medigap” policy from a private insurance carrier. Medigap plans supplement Medicare coverage and help to offset the out-of-pocket cost of care. They function very much like traditional insurance policies, just on a much more narrow scale. That means they have their own deductible that must be met before coverage kicks in.
Get a Consultation
The best way to determine what cataract surgery will cost you is to schedule a consultation with a surgeon to discuss treatment options. The surgeon will be able to provide you a cost estimate for your unique considerations. You can also speak with your insurance carrier for more specifics about what your policy covers. Medicare patients can visit Medicare.gov to learn more, or contact the organization at 1-800-MEDICARE to speak with a representative.