Cataract Surgery Costs

There are several different costs associated with cataract surgery, and the exact cost to each individual patient is different, depending on several factors.

The costs that all patients face include the pre-operative evaluation, eye measurements for intraocular lenses, the actual surgical costs and the prescription medications taken both before and after surgery. The surgical costs include the cataract surgeon’s fee, the anesthesiology fee and the facility fee (hospital or outpatient surgery center fees where the surgery is performed). The total cost will depend on your location and insurance company, and the direct cost to the patient depends on insurance and/or Medicare coverage. These costs are different for all insurance companies, and Medicare costs vary depending on where you live and whether or not you have secondary insurance in addition to Medicare.

Some insurance plans have a co-pay policy for office visits, testing and surgery. With a co-pay policy, patients must pay either a flat fee, or a percentage of the different types of medical charges. Some will also have a deductible (an amount for which a patient is responsible before insurance begins to pay charges). Co-pay policies and/or the deductible typically apply to “covered services,” those services that your insurance company contractually agrees to cover, and are generally deemed medically necessary. This is determined by your insurance provider, and you can obtain information on this either from your insurance contract or directly from your insurance provider.

If your cataract surgery is deemed medically necessary by your insurance provider, the majority of these costs are usually covered after any unused portion of your deductible has been met. Standard or conventional cataract surgery includes the placement of a monofocal, intraocular lens at the time of cataract surgery.

There are some additional costs associated with optional cataract surgery procedures that are not usually covered by your insurance carrier. These “non-covered” services include procedures to reduce dependence on glasses following cataract surgery, such as limbal relaxing incisions to treat astigmatism, premium intraocular lenses – presbyopia-correcting IOLs (multifocal and accommodating lens implants) and astigmatism-correcting IOLs (toric lens implants) – and laser vision correction. If you choose to have any of these procedures performed, you will typically be responsible for 100% of the costs. Such procedures are considered optional beyond standard cataract surgery, and are not “medically necessary,” which is why they are not covered by most insurance carriers, including Medicare.

Prior to your surgery, your cataract surgeon’s staff should inform you about the exact costs of non-covered services (e.g., limbal relaxing incisions and/or premium IOLs) for which you will be responsible. In addition, they may be able to estimate the portion of covered services for which you will be responsible (co-pay, etc.). However, you may have to contact your insurance carrier directly to find out your exact share of the costs for covered services.

In summary, your costs will depend on your insurance company and the procedure you choose. Covered services usually include:

Cataract evaluation

Pre-operative testing and measurements (excluding corneal topography)

Cataract surgery with monofocal lens implant (which includes related post-operative care for 90 days)

Anesthesia fee

Hospital/ambulatory surgery center fee

Some medications may be covered

Non-covered services include:

Premium IOLs (toric, accommodating and multifocal)

Limbal relaxing incisions

Laser vision correction

Corneal Topography (except in certain conditions)

Some medications may not be covered

If you have a visually significant cataract, and removal is determined to be medically necessary, your insurance company will usually cover this procedure, but you will be responsible for your co-pay contribution and/or deductible for the surgery and its associated costs. The co-pay contribution and deductible are set by your insurance company and will depend on your contract. If you elect to have a premium IOL and/or surgical treatment of your astigmatism, you will be directly responsible for that additional cost, as this is not generally covered by commercial insurance. The additional cost of premium IOLs and astigmatism treatment will vary depending on the procedure you choose, where you live and your particular eye condition.

Your ophthalmologist’s office can help you determine exactly what the costs will be for both non-covered and covered services to help you plan and select treatment options. Therefore, you should be able to estimate the total cost before you undergo surgery.