No More Cataracts! & Benefits©

A few years ago my eye doctor told me that he thought I qualified to have Medicare cover the removal of my cataracts. He referred me at the time to a specialist in Albany, GA. I followed through with the appointment and, sure enough, the eye surgeon agreed that I qualified under the Medicare criteria, to have cataract removal surgery. During the consultation I was advised that for an additional fee I could have corrective lenses installed as well. At the time, I believe the cost of those lenses was approximately $2500, so I opted to have just one eye done until the piggy bank was full enough to go back and get the other eye done as well. The results were incredible! The one corrected eye now has perfect vision and lets me see full vibrant color as well!

Recently, my wife was told by her eye doctor that her eyes now needed cataract surgery and, contrary to what she had been told previously, that corrective lenses could be installed to correct her vision; this was no small thing to hear! For years she was under the impression that if and when she had cataract surgery she would still have to wear glasses or contacts.

So, last week she had the surgery in one eye with the second scheduled for the last week in November. Ever since she got home from the surgery she's been covering one eye then the other like a little girl exclaiming "I can't believe it....I can see and read without glasses and the colors.....wow!"

So with that going on in the background all week I thought it might be timely to let you know how Medicare looks (pun intended) at your cataracts. I went to a couple Medicare websites and they were far too technical for this column so I opted to ask Chat gpt (Artificial Intelligence) for some help and what it gave me was spot on with the experience that both my wife and I had. So, here we go:

Medicare typically covers cataract surgery if certain criteria are met. Here's an overview of the requirements:

1. Medically Necessary Procedure
Medicare will cover cataract surgery if it is considered medically necessary. This means the cataract must be affecting your vision to the extent that it interferes with daily activities like reading, driving, or working.

2. Confirmation of Cataract Diagnosis
You will need to have a formal diagnosis of cataracts from your eye doctor, usually following a comprehensive eye exam. Your eye doctor will assess the severity of the cataracts and how much they are impairing your vision.

3. Symptoms or Impact on Function
Medicare generally requires that the cataracts cause symptoms like blurred vision, glare, difficulty reading, or trouble seeing at night. If the cataract is not severely affecting your vision or ability to perform daily tasks, Medicare may not cover surgery.

4. Pre-Surgical Consultation
Your eye doctor may need to demonstrate that conservative treatments (like stronger glasses or magnifying lenses) are not sufficient to correct your vision before recommending surgery. Medicare may not approve surgery if less invasive options are available.

5. Covered Services for Cataract Surgery
If approved, Medicare generally covers:

• Surgical costs for the procedure itself (performed in an outpatient surgical center or hospital).
• Facility charges related to the surgery.
• Post-operative care, including follow-up visits and any necessary eye drops or medications.

Note that Medicare typically only covers a basic intraocular lens (IOL) for replacement. If you opt for a more advanced or specialized lens (e.g., multifocal lenses or lenses that reduce the need for glasses), you may be required to pay the difference out-of-pocket.

6. Part A and Part B Coverage

• Medicare Part A: Covers the hospital stay if you require admission for the surgery (e.g., if it's done in a hospital rather than an outpatient setting).
• Medicare Part B: Covers the physician’s services, the surgical procedure, and any outpatient care. You may be responsible for the Part B deductible and coinsurance (usually 20% of the Medicare-approved amount).

7. Medicare Advantage (Part C) Plans
If you have a Medicare Advantage plan, it typically follows the same guidelines as Original Medicare but may offer additional benefits or cost savings. Be sure to confirm with your plan for specifics.

8. Exclusions or Limitations

• Medicare does not cover the cost of premium lenses or extra costs for a more advanced procedure (like LASIK for cataracts).
• Routine eye exams for vision correction (i.e., for glasses or contacts) are not covered by Medicare, though the eye exam related to the cataract diagnosis is covered if surgery is deemed necessary.

To ensure your cataract surgery will be covered, it’s a good idea to have a discussion with your eye doctor and Medicare or your Medicare Advantage plan to confirm the details and avoid any unexpected costs.

I hope this was helpful to you or any of your loved ones who may be needing cataract surgery.

Two final words: 1. If your doctor tells you might qualify, don't put it off; you will marvel at the difference, especially if you're eligible for corrective lenses! 2. Both of our experiences were more hassle-free than the above overview portrays it. If you need it, go for it!

Thanks for reading All About Seniors.....see you next week!

Bill Milby, CSA, is a Certified Senior Advisor and a Director of Visiting Angels® of Macon, a non-medical, living assistance service for seniors.  If you have questions or comments about this column you can reach him at william.mercylink@gmail.com or  search for  us at www.facebook.com/VisitingAngelsofCentralGA/