The Cost of Cataract Surgery With or Without Insurance

Cataract surgery costs an average of $3,500 and can range up to $7,000 per eye.

Both private insurance companies and Medicare can cover the majority of the costs associated with cataract surgery. You can still incur some out-of-pocket expenses, depending on your specific plan, carrier, and policy.

More than half of all American adults ages 80 or older have, or have had, cataracts. Cataract surgery is one of the most common surgical procedures in the world. It is typically deemed medically necessary once the cataract is interfering with daily life tasks, such as driving, reading, or watching television.

Cataract surgery is the only treatment for cataracts. It is considered a safe and effective method for improving eyesight related to cataracts.

How Much Does Cataract Surgery Cost?

Cataract surgery is the only treatment for cataracts.

The average cost of cataract surgery is $3,500, though prices vary greatly according to doctor, facility, and location. This cost includes the examinations and preoperative expenses, the actual surgery, the surgeon’s time, overhead costs for technology and office space, the price of the new lens, and postoperative care, which can include medications.

The exact cost of cataract surgery can be influenced by a variety of factors.

• Type of IOL (intraocular lens) used: Premium and toric IOLs can be used to correct refractive error and astigmatism respectively. These lenses can cost more. Premium refractive IOLs generally cost around $2,500 per lens, while toric IOLs can cost around $1,500 per lens. A standard monofocal IOL will cost significantly less and often be covered by insurance.
• Technology: The type of technology used can also impact cost with laser-assisted cataract surgery, often increasing costs by at least $1,500 per eye.
• Surgeon: The experience and name recognition of the surgeon can influence the cost. Those in higher demand will garner a higher price for their time.
• Location: Your geographical location will drive the price as well the actual clinic or surgery center where the cataract surgery is performed.
• Difficulty of surgery: More preoperative and postoperative care and medications add to the price. If more complicated procedures are required, based on your eye health and condition, the cost will likely be higher.

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Does Insurance Cover Cataract Surgery?

Typically, insurance will cover the majority of the costs associated with cataract surgery.

To be covered under insurance, the cataract will generally need to be advanced enough to be impairing your vision to a specific degree outlined by the policy or carrier. When your vision tests to the set level of clarity or acuity, cataract surgery is deemed a medically necessary procedure and therefore covered by insurance.

You will usually need to reach a certain deductible amount before costs are covered. Depending on your policy, insurance coverage can vary based on a percentage. For example, insurance plans can cover up to 100 percent of eligible expenses or a percentage of this. You are responsible for the remaining percentage.

Insurance plans often require a co-pay for services. The service can cost more or not be covered at all if you choose an out-of-network provider. Ask your insurance provider the following questions:

• What amount of coverage is provided for cataract surgery?
• What are the out-of-pocket expenses I can expect to pay?
• Does the surgery need to be performed by a specific doctor or clinic (an in-network provider, for example)?
• What level of vision impairment is necessary for coverage?
• What type of IOLs are considered covered?
• What is included in the cost (such as medications, preoperative and postoperative care, or prescription eyewear after the surgery)?

Do Medicare or Medicaid Cover Surgery?

Medicare is offered to adults over age 65 in the U.S. Since cataracts are often an age-related concern, this is often the insurance option for cataract surgery.

Vision benefits, such as prescription eyewear, are generally not covered by Medicare. However, cataract surgery is considered a medically necessary procedure; therefore, it is covered.

Medicare generally covers up to 80 percent of the cost of cataract surgery, leaving you with the remaining 20 percent to cover, plus your deductible. Medicare will cover traditional cataract surgery, a monofocal IOL implant, and one set of prescription eyeglasses or contact lenses after the surgery.

Again, Medicare will require your vision acuity and clarity to test at a specific level to deem the surgery necessary.

If you are not yet eligible for Medicare and fall under Medicaid, you can get cataract surgery covered through the optional vision benefits. These benefits are determined on a state-by-state basis. You will need to check with your state and your specific plan to find out your coverage specifics.

What Can Increase the Cost of Cataract Surgery?

If you choose to have premium IOLs implanted or a more modern technique used, this can drive up the cost of cataract surgery.

Cataract surgery is commonly covered by both private medical insurance (not vision insurance) and Medicare up to a point. If you choose to have premium IOLs implanted or a more modern technique used such as laser-assisted surgery, this can drive up the cost of cataract surgery.

Placing a premium lens instead of a basic IOL can help to correct for astigmatism or refractive error. This can then save you money on corrective eyewear, but this will drastically increase the cost of the surgery overall. You will likely need to pay this out-of-pocket, as it will often not be covered through insurance.

If you choose not to wait for the cataract to be bad enough to be covered under insurance, or you do not have insurance coverage for cataract surgery, there are financing options available. Most clinics and eye care centers will offer payment plans or the ability to finance the surgery.

Health savings accounts (HSAs) and flexible spending accounts (FSAs) can also be used to pay for medical expenses that are not covered through insurance. This can include costs associated with cataract surgery.

References

1. Cataract. (December 2021). U.S. National Library of Medicine (NLM).

2. Cataract Surgery. (October 2011). CMAJ.

3. Eyeglasses and Contact Lenses. Medicare.gov.