2024 Cataract Surgery Financial Considerations

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Cost is always an important consideration in any medical treatment. Below is a general idea of typical surgery-related costs that are the patient's responsibility AFTER insurance coverage:

Standard Lens  - Covered 

• Corrects vision at ONE distance (distance or near)
• Does not correct astigmatism  
• Coinsurance will apply for the actual procedure depending on your plan; see above 

Premium Lens 

Toric Lens - $1,500 per eye

• Corrects vision at one distance like the standard implant AND corrects astigmatism (abnormal curvature of cornea), increasing the chance for independence of glasses following surgery. 
• The amount you are responsible for accounts for the extra steps required during the procedure to prepare the implant for insertion and the lens itself
• Not covered by insurance 
• Considered a cosmetic enhancement by insurance companies

Premium Lens 

PanOptix Multifocal Lens - $2,500 per eye

• Corrects vision at multiple distances  AND corrects astigmatism (abnormal curvature of cornea), increasing the chance for independence of glasses following surgery. 
• The amount you are responsible for account for the extra steps required during the procedure to prepare the implant for insertion and the lens itself
• Not covered by insurance 
• Considered a cosmetic enhancement by insurance companies

Combination Drops, $70 per eye, not covered by insurance: Custom formulation to decrease the amount of drops taken per day and to decrease physical discomfort after surgery. Since this is a custom compounded medication it is not covered by insurance. Patients pay the office directly at their preoperative appointment. Drops are dispensed at the measurement appointment.

OR

Prescription Drops, cost is variable, may be covered by insurance: We can send a prescription to your preferred pharmacy for the required drops after surgery. They will be in three separate bottles. Cost is determined by each individual insurance plan. Anticipated cost is anywhere from $5-$60 per bottle (average $15-$180 per eye). 

Facility Fee The amount you are responsible for to use the facility after insurance coverage. 

• Each individual plan has a different amount, average is approximately $195-$398 per eye 
• Paid prior to date of surgery. 
•  Proliance Surgeons will contact you and go over their costs before your procedure.  
• Due in full before date of surgery. Payment plans available on a case-by-case basis.

Anesthesiologist (Pacific Anesthesia) - $ Variable 

• This is calculated by the minute. 
• Billed after surgery is performed. 

Patient’s scheduling surgery are responsible for knowing their specific plan limitations. 

Our office cannot give an accurate estimate because it has to be billed by insurance first and every plan is different. To get a better estimate of your out-of-pocket potential please call your insurance company customer service number on the back of your insurance card and ask what your anticipated expenses are for each service code below: 

Procedure: 66982, 66983, 66984, 66985, 66986  

Toric Lens Insertion: V2787    

Refraction (glasses prescription after surgery) 92015 

Ask your insurance company:   

• I am having cataract surgery, am I covered for (code)? 
• What is my out-of-pocket estimate for (code)? 

The main factors that affect the average cost of cataract surgery include:

• Type of lens. The type of intraocular lens (IOL) you need affects the overall cost. A monofocal lens that corrects vision at one distance is less expensive than a multifocal lens. Premium lenses include toric IOLs to correct astigmatism and presbyopia-correcting IOLs.
• Type of surgery. Traditional surgical techniques, such as phacoemulsification, are lower in cost. We do not offer laser-assisted surgery options at this time.
• Surgeon’s fees. A surgeon’s experience and reputation often affect their fees.
• Surgery setting. Ambulatory surgical centers typically cost less than outpatient surgery in a hospital.
• Pre- and post-operative care. Pre- and post-operative doctor’s visits, medications, and testing can impact the overall cost.

These variables will affect the on-paper cost of your cataract surgery. However, your health insurance coverage is the biggest factor in determining your out-of-pocket cost.

Yes, basic cataract surgery is covered by Medicare when medically necessary. Medicare typically covers 80% of expenses related to cataract surgery. It also covers a portion of the lenses for one pair of eyeglasses or contact lenses after the surgery. 

Medicare Part A covers hospital stays and other inpatient procedure costs. Most cataract surgeries will not require the patient to remain overnight. But if yours does, your hospital expenses should be covered by Part A.

Medicare Part B covers medically necessary health care procedures and services.

Part B will cover:

• Your pre-surgery appointments
• The surgical procedure
• Monofocal lenses
• Post-surgery outpatient services.

Here are some things to think about regarding Medicare coverage:

• You will be required to pay your deductible and copayment
• Monofocal IOLs are covered by Medicare
• If you want premium IOLs, you will have to pay the difference these include:
  • Astigmatism-correcting IOLs (A-C IOLs)
  • Multifocal lens implants (PanOptix lenses)

These services can double or triple out-of-pocket expenses. It is possible to purchase a “Medigap” policy from a private health insurance company. These plans provide supplemental coverage for health services not covered by Medicare. They often cover the additional costs of premium cataract eye surgery. 

Speak directly with your Medicare representative before having cataract surgery. They’ll help you to determine the total cost of your operation.

Most private health insurance providers consider cataract surgery to be medically necessary. Therefore they will cover at least a portion of the costs associated.

An FSA allows you to pay for many medical expenses using pre-tax income from your employer. Contributions to a health FSA can’t exceed more than $2,750 annually. That amount might be lower depending on your employer.

Depending on the total cost of your cataract surgery, your FSA may not cover the full amount.

An HSA is a tax-exempt account to help pay or reimburse qualified medical expenses. You must meet certain eligibility requirements for an HSA, including:

• Being enrolled in a high-deductible health plan (HDHP)
• Having no other health coverage, including Medicare
• No one claims you as a dependent on their tax return

Unlike an FSA, unspent money in an HSA rolls over at the end of the year. You may be able to save enough money to cover the full cost of cataract surgery over one or more years.