Something that often comes with age is a decrease in your eyesight. According to a study conducted by the University of Michigan Kellogg Eye Center, 92% of Medicare beneficiaries use eyeglasses. Many seniors opt for LASIK surgery to help with specific vision problems, and often seniors undergo cataract surgery since a high number of seniors form cataracts. You might now be thinking, “Does Medicare cover eye surgery?” Keep reading to find out!
What Medicare covers
Medicare covers many services under Medicare Part A, inpatient coverage, and Part B, which is outpatient coverage. In order to get your healthcare services covered by Medicare, your services and procedures must be medically necessary. When a service is needed to treat or diagnose an injury, disease, or illness, it is often considered medically necessary, and Medicare would likely cover it.
Medicare Part A covers inpatient services, such as a semi-private hospital room, hospital meals, skilled nursing, hospice, and more. Part B is your outpatient coverage and covers things such as doctor’s visits, durable medical equipment, ambulance rides, and much more.
What Medicare does not cover
There are many services Medicare covers, but it does not cover all healthcare services. Unfortunately, routine eye services do not fall under the medically necessary category. Medicare does not cover routine eye exams, glasses, or contacts. But if you develop cataracts, Medicare does step in.
Many seniors become more susceptible to cataracts as they grow older. For example, by age 80, over 50% of seniors have a cataract in at least one of their eyes. Cataract surgery is currently the only effective treatment to help restore your eyesight. Medicare recognizes this, which is why Medicare covers cataract surgery.
No matter if your cataract surgery takes place in an inpatient or outpatient setting, Medicare covers it. Typically, cataract surgery is an outpatient procedure, so often, Medicare Part B covers the surgery. Cataract surgery is about an hour-long procedure, and you would likely be awake during the surgery.
If you receive cataract surgery at an outpatient facility, you would be subject to the Part B deductible and then pay a 20% coinsurance after the deductible is met. Now, let’s say you are required to be an inpatient during your cataract surgery. In this case, you pay the Part A deductible instead of the Part B deductible. But, if you have a Medigap plan, your plan will likely pick up your out-of-pocket costs.
Medicare Part D covers many medications, or eye drops necessary if your doctor prescribes it before or after your cataract surgery.
Many seniors require corrective lenses or glasses after their cataract surgery. If this is the case for you, Medicare Part B helps pay for either one pair of eyeglasses with standard frames or a set of contact lenses. Again, if you have a Medigap plan, your plan will likely help cover these costs.
Many seniors undergo laser-assisted in situ keratomileusis (LASIK) surgery to help with their poor vision. LASIK surgery can help improve one’s nearsightedness, farsightedness, or astigmatism after the surgery is performed. After the surgery, many seniors no longer require glasses or contact lenses as LASIK can help bring back 20/20 vision.
LASIK surgery is an elective surgery, which is a non-medical emergency surgery. Since LASIK surgery does not help treat or diagnose an injury, disease, or illness, Medicare does not consider it medically necessary. If you undergo LASIK surgery, expect to pay 100% of your medical bill, as Medicare will deny coverage.
However, if you are considering a Medicare Advantage plan and LASIK surgery is crucial to you, then consider researching the available plans in your area that offer a vision benefit. There may be a plan in your area that would help cover the cost of LASIK surgery. But keep in mind Medicare Advantage plans change from year to year, so the vision benefit might leave your plan the following year.
Medicare will cover eye surgery, such as cataract surgery if it’s medically necessary. However, it will not cover services such as routine vision exams or LASIK eye surgery. For more information on Medicare’s vision coverage, visit Medicare.gov to learn more.