Wednesday, June 15, 2022

Is Cataract Surgery Covered By Health Insurance

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Does Health Insurance Cover Cataract Surgery

Does Medicare Cover Cataract Surgery?

A cataract is one of the most common occurring eye-related disorders in India. It is commonly known as the clouding of the lens of ones eye. The condition gradually develops in the eye. This layer of cloudiness slowly blurs the vision or causes double vision. The cataract blocks the natural vision of a person causing excessive discomfort. If not treated in time, this can lead to loss of vision or blindness. Therefore, it is important to treat the condition quickly to avoid complications.

Let us understand what a cataract is and whether your health insurance covers a cataract.

What is a Cataract?

Cataract refers to the cloudiness in ones eye lens, which reduces the visibility of the person. In addition, as people grow older, their eye lens becomes thicker because of the deposits. This dense and clouded area makes the cornea opaque and leads to a reduction in its flexibility.

Cataract surgery is one of the most common minor surgeries that people in India opt for. This indicates that the surgery is a much-needed one among Indians.

Symptoms of Cataract

Cataract leads to problems with vision as the lumps do not allow clear images to be sent to the retina. This leads to complete or partial blindness. Therefore, getting surgery done is one of the best options to restore your vision in such situations.

While this issue is common among older people, younger people might sometimes experience the symptoms of this condition.

The symptoms of cataract are:

These include:

What Is A Cataract

Cataract is a disease associated with the human eye. It causes clouding in the eye leading to impaired vision. There are three types of cataracts subcapsular, nuclear, and cortical. If not treated promptly it can also lead to blindness. If you feel your vision has been hazy and blurred for a long time, it is suggested to visit an eye doctor at the earliest.

Points To Keep In Mind While Opting For A Health Plan For Possible Cataract Surgery:

  • Waiting Period: Most health insurance plans have a 24 month or more waiting period for cataract eye surgery. Therefore, the plan would cover the medical expenses of cataract surgery only when it is performed after 24 months of continuance coverage from the date of initial policy purchase.
  • Cap on Claim: For example, you have a health plan with the sum insured of Rs. 5 lakhs. And in your plan, cataract eye surgery is covered till up to 10% of the sum is insured. So, the expenses are only up to Rs. 50,000 would be covered. There are also specific plans that do not put any cap on expenses and pay for the actual cost of the treatment, as covered by the sum insured.
  • Co-Payment: There is a clause of co-payment in some health insurance plans when certain surgeries such as cataract surgery are performed. This means that in the total expenses of the treatment, a certain percentage of 20% to 30% is paid by the policyholder. For example, if you have to copy 25% of the expenses, and if the cost of your cataract surgery were Rs. 1 lakh, you would have to pay Rs. 25,000 from your pocket. The insurance company would pay the remaining Rs. 75,000.
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    What Do Different Insurance Companies Cover Related To Cataract Surgery

    Because cataracts are most likely to develop in people who are 40 and older, Medicaid and Medicare will cover basic cataract treatment and surgery. According to, cataract surgery is considered medically necessary. While other vision treatment is not covered by this government insurance program, cataract surgery is.

    Medicare Part B will help cover the cost of reading glasses after cataract surgery, which will most likely be needed since monofocal lenses are covered by Medicare, but multifocal or toric lenses are not. The program also covers the cost of contact lenses after cataract surgery.

    It is important to note that Medicare does not cover vision treatment except after a medically necessary procedure like cataract surgery. Part B provisions include the following:

    • You will pay 20 percent of the Medicare-approved cost of one pair of eyeglasses or some set of contact lenses after cataract surgery with a monofocal interocular lens.
    • The supplier of glasses and contact lenses must be enrolled in the Medicare program.
    • Any additional costs, such as upgraded lenses in glasses, must be covered by you.
    • The Part B deductible applies to these options.

    Other major insurance companies follow similar coverage standards. For example, Cigna states that they do not cover treatment for most eye or vision problems, except in the event of:

    This insurance plan does not cover:

    Why Wont Medical Insurance Cover These Advanced Procedures

    Is Cataract Surgery Covered By Medical Insurance

    Medical insurance only covers cataract surgery because a person can end up blind without the surgery, so it’s considered medically necessary. However, any advanced cataract surgery procedure can be argued:

    While less convenient than a premium IOL, medical insurance providers argue that a patient can simply wear reading glasses to see up close. If they want a premium IOL or multifocal IOL for better near vision, that’s an added expense.

    Medical insurance, in general, doesn’t cover vision correction. Patients who wear eyeglasses and contacts already know that to see well that they must pay for their eyewear. Or, they use their vision insurance to cover these costs. So, just like in eyewear, health insurance policies will not cover advanced cataract surgeries that merely correct your vision further.

    Laser vision correction does provide a permanent solution for myopia or presbyopia. However, almost the entire cost is out-of-pocket. This is due to the fact that LASIK surgery is considered an elective procedure, thus, medically unnecessary. The same goes for any premium IOL.

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    How Much Will Cataract Surgery Cost

    The cost of cataract surgery will depend on your geographic location, the type of procedure you want , the IOL you select and the surgeon and facility you choose.

    Most private health plans have a deductible, a set amount you have to pay out-of-pocket for covered medical expenses before your insurance begins to pay. For example, you may have a $1,500 deductible. When you have spent $1,500 toward covered services, you usually only have to pay a co-pay or coinsurance for future covered medical expenses.

    If you are on Medicare, you also have an out-of-pocket maximum you must meet. This is the maximum amount you have to pay each year for covered medical expenses before your Medicare plan pays 100 percent of your covered services.

    If I Have Diabetes Does This Mean I Will Get Cataract Too

    No, just because you are diabetic doesnt mean you will get cataract. However, its said that people who are diabetic are more prone to getting secondary cataract too.

    No, just because you are diabetic doesnt mean you will get cataract. However, its said that people who are diabetic are more prone to getting secondary cataract too.

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    The Details Regarding The Cost Of Cataract Surgery

    If only there were a simple answer to this question. Every medical and surgical procedure is associated with a CPT code . The CPT code for cataract surgery is 66984, although 66982 is also a cataract surgery code used when the cataract surgery is complex, which can happen for any number of reasons.

    When it comes to the cost of any medical or surgical procedure, every doctor, medical office, and hospital comes up with a price for any given CPT code. Think of this as the sticker price. Keep in mind that hardly anyone ever pays the sticker price. When doctors decide to be in-network with any insurance company, they accept and/or negotiate rates for various CPT codes. Also keep in mind that many surgery CPT codes and their associated charges include post-operative visits in that one cost.

    As an example, the surgeon fee sticker price for cataract surgery may be $1500, but the surgeon has agreed to accept, say, $900 from Blue Cross Blue Shield . In that case, for a patient with BCBS, the surgeon fee is $900. Now whether it is BCBS or the patient that pays that $900 depends on the actual BCBS plan and any relevant deductibles, co-insurance, and co-payments. In my experience, the average patient would usually have to pay about $150 of this $900 based on the most common plans, with BCBS paying the rest.

    Cataract Surgery

    Things To Note In Health Insurance Plans

    Medicare Coverage – Medicare Vision Coverage: Does Medicare cover Cataract Surgery

    As noted, more and more health insurers in the market have started providing coverage for cataract treatments. With the increase in lifestyle-related diseases, it is not uncommon for someone in their 40s or 50s to get cataract. Health insurers are aware of this fact. Hence, they provide coverage for cataract only upon satisfaction of certain terms and conditions.

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    When Is The Need For Surgery

    Cataract is diagnosed via tests like slit-lamp test, visual acuity test and dilated eye test. Since cataract cannot be treated without surgical intervention, doctors recommend surgery if cataract is detected. Though there may be cases where cataract is not impairing the vision and there are no symptoms as well. In these rare cases, surgery may not be required as cataract is not causing any trouble. In severe cases, and if not operated timely, cataract can lead to inflammation and conditions like glaucoma.

    Waiting Period For Cataract Surgery

    The insured needs to serve the waiting period to utilize cataract treatment coverage. Generally, the waiting period in most of the health insurance companies is for 2 years for treatment-related cataracts. But, it should be confirmed with the concerned insurance company if they provide the facility.

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    What Does Medicare Pay Toward Cataract Surgery

    The standard cataract surgery, which uses the standard intraocular lenses is covered by Medicare, but, if you want to upgrade and place specialized lenses, most probably, you will be the one who will pay for this cost.

    In general, here are the services covered by Medicare in the cataract surgery:

    • Lens implantation
    • Cataract removal
    • A pair of prescription glasses with standard frame or contact lenses

    For other services related to the surgery but not fully covered by Medicare, you need to pay 20% as Medicare coinsurance and other deductibles of the expenses, before Medicare will pay its share. These are directly related to the procedure such as the following:

    • Electrocardiogram to determine your heart condition before you will undergo the surgery
    • Comprehensive eye examination that includes precise eye measurements of the refractive errors
    • Professional fee of the anesthesiologist or the attending nurse anesthetist during the procedure
    • Follow up procedure or medical care needed for any complications related to the cataract surgery. This is outside the 90 days given for post-operative care.

    If you have a pre-existing condition that is not covered by Medicare before developing cataracts, you may treat that condition during the surgery, but Medicare will not pay for the fees that are not related to the cataract surgery.

    All About Cataract Treatment Coverage In Your Health Insurance

    Does Medicare Cover Cataract Surgery? Here

    Team AckoFeb 22, 2022

    Eyes enable you to see the world. They are often appreciated with adjectives such as beautiful, soulful, intense, etc. People get uneasy even if a tiny dust particle enters the eye. Thus, one can only imagine the discomfort associated with eye-related diseases.

    One of the prominent issues associated with human eyes is cataracts. And like in the case of other major diseases, people look towards medical insurance plans to safeguard their finances with respect to cataract surgery.

    Read ahead to know more about cataract treatment coverage in medical insurance plans.

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    Health Insurance Covering Cataract Surgery

    • 09/02/2022

    Protecting your eye and maintaining its good health should be a priority in your life. It is something that is most important at every stage in your life. A cataract is an eye condition that can develop in individuals as you get older, and if left untreated, it can lead to partial or complete blindness. Therefore, you must stay prepared to pay for such expenses if it affects your eye. So, how can you stay financially protected? Is cataract surgery covered by Insurance? Well, yes! A health insurance plan can cover cataract surgery expenses in India. Let us get into the details to understand cataract surgery covered by insurance.

    Is Cataract Surgery Covered In Health Insurance

    Against the strain of public confusion, cataract surgeries are in fact covered under health insurance plans. With the advancement of science and technology, a cataract surgery can today be performed within a day as part of day care procedures in hospitals. Many health insurance policies offer a coverage of innumerable daycare procedures that incorporate the cost of cataract surgeries and you should check the policy documents properly at the time of purchasing the policy. In case you already hold a health insurance policy, you can revert back to those documents to check the inclusions and exclusions of your plan.

    Now, let us take a look at some of the most prominent health insurance plans that offer coverage of cataract surgeries.

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    How Can You Enroll In A Cigna Plan That Covers Cataract Surgery

    Cigna health insurance and Medicare Advantage plans have specific eligibility rules and enrollment periods, so its recommended to check your eligibility and find out when you may sign up for coverage.

    Connecting with a licensed insurance agent will allow you to review your coverage options available from Cigna and other providers in your area to help you narrow down the best choice for your needs.

    Cataract Coverage In Group Insurance Plans

    Premium Lens Options for Cataract Surgery

    If you are under the coverage of employer group insurance plans, then there will be no waiting period for any pre-existing conditions. You can go for cataract treatments immediately without any waiting period. For a group insurance policy, there is no sub-limit in the case of cataract treatment. Ask your policy provider whether cataract surgery is covered by insurance cover given to the group or not. You can ask your service provider regarding the same or go through the policy documents carefully.

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    Cataract Surgery And Health Insurance:

    Apart from surgery, a cataract does not have a natural cure. Average conventional cataract operation may cost Rs. 40,000 for an eye. But if you opt for a bladeless/ laser eye surgery, you may have to shed anything between Rs. 80,000 to Rs. 1.5 lakhs. Laser eye surgery cost is high it is, therefore, only natural that you would be concerned if your health insurance plan would cover this treatment.

    Answer is “Yes”,Cataract Surgery is covered in Health Insurance.

    Several health insurance plans may cover the medical expenses of cataract surgery, but it comes with its own set of terms and conditions.

    Different Types Of Cataracts

    Depending on which part of the lens the cataract develops in, or how it develops, there are five categories:

    • Nuclear cataract: This type forms in the middle or central zone of the lens. A nuclear cataract may first cause nearsightedness, but gradually the lens turns yellow and clouds your vision. As the condition progresses, the eye lens may become brown and make distinguishing between different colours difficult. This type is associated with ageing.

    • Cortical cataract: This wedge-shaped cataract occurs in the lens cortex. It starts from the outer edge of the lens and slowly works its way to the centre.

    • Subcapsular cataract: This cataract starts as a small, opaque area near the back of the lens and on the path of light. It often makes reading difficult, causes glare around lights at night, and makes vision blurred in bright light. It is common in people with diabetes or those taking steroid medications for a long time.

    • Congenital cataract: This type is present at birth or develops during a childs first year. A congenital cataract is less common than the other types.

    • Traumatic cataract: One may develop a traumatic cataract after an eye injury. However, it may take many years for this to happen.

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    Does Cataract Surgery Come Under Health Insurance

    Yes, cataract surgery is included in health insurance coverage. With specific criteria, one can take a selected plan for their cataract surgery. These criteria include a waiting period of 2 years, the average expense of Rs. 15,000 to Rs 35,000 and given in sublimity.It is preferable to take senior citizen plans if the patient is of late adulthood. This coverage includes hospitalization, surgery, medical expenses, and post-surgery expenses as well.

    Does Cataract Surgery Come Under Health Insurance And The Cost Of Surgery In India

    Do health insurance plans cover cataract surgery ...

    A cataract is one of the widely occurring disorders in India. It is commonly known as the clouding of eyes. This condition develops slowly with time. Gradually, a layer occurs on the lens making the vision blur or results in double vision. The cataract blocks the view of natural vision causing great discomfort. Slowly, this deteriorates to blindness or loss of vision. So it is necessary to remove cataract before time.

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    Why Mann Eye Institute

    Our surgeons are among the most experienced cataract surgeons in the country. For over 40 years, the accomplished refractive and cataract specialists at Mann Eye Institute have been at the forefront of vision correction. Our unwavering commitment to personalized patient care, advanced surgical expertise and outstanding results have earned us a reputation for excellence in eye care.

    Are you ready to See Life Better? Were ready to help. Schedule your cataract evaluation today.

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