Cataract Surgery Costs

If you're at the point of debating surgery, chances are, your hands are tied. You need to do it—for your own health and quality of life. Don’t let financial worries hold you back. There are payment options available. They vary by insurance and the type of replacement lens   Lens: The transparent disc behind the pupil that brings light into focus on the retina.   involved, but a few standards do apply, such as:

  • If you choose a monofocal (standard fixed focus) lens, the entire procedure is usually covered.
  • If you choose a multifocal or astigmatism-correcting lens, you probably will have to pay a portion of the cost.

Here are some options you do have:

Medicare Coverage and Cataract Surgery Costs

In May of 2005, the Centers for Medicare and Medicaid Services (CMS) clarified their payment rules to offer Medicare beneficiaries the option to select presbyopia-correcting intraocular lenses (IOLs) and elect to pay additional charges for advanced technology lenses, such as the AcrySof® IQ ReSTOR® IOL and AcrySof® IQ Toric IOL.

Prior to the CMS ruling, Medicare limitations prevented beneficiaries from choosing to purchase these lenses. Under the new policy, Medicare will continue to pay existing reimbursement amounts for cataract surgery, and patients may opt to pay additional fees for the more advanced lenses.

Private Insurance

Private insurance policies vary, but most cover cataract surgeries involving a conventional monofocal IOL. Many insurance companies are following Medicare's example and offering patients the choice of paying the difference between a standard and specialized lens. Some people may find that the chance for full-range vision and freedom from glasses is worth the extra out-of-pocket expense for multifocal lenses like the AcrySof® IQ ReSTOR® IOL.

Before you make any decisions, you should talk with someone at your doctor's office or primary insurance provider and confirm what is covered under your policy, so you and your doctor can select the lens that best fits your individual needs.

For more information regarding private coverage, download this Elective Intraocular Lens Reimbursement Guide from Alcon Reimbursement Services.

Flexible Spending

Regardless of coverage, you may have the option of deducting the outstanding costs of your surgery from your Flexible Spending Account (FSA). An FSA allows you to set aside a predetermined portion of your wages for medical expenses and childcare. The money deducted from this account is not subject to payroll taxes.

Doctor Payment Plans

Many eye doctors also offer you the option of paying for your surgery over time. If the idea of financing your surgery appeals to you, ask your doctor what type of payment plans he or she offers. Be sure you also understand the total cost upfront and what that includes.