Our nation may spend $2.5 billion to land a space vehicle named“Curiosity” on Mars, and marvel at this scientific breakthrough. But, there are other marvelous discoveries like lens implant eye corrections happening everyday right here on earth for way less money.
In the United States, approximately one million patients a yearreceive a lens implant at the time of cataract removal which restores normal vision in most cases regardless of age or eye size. Regular glasses with a bifocal are usually worn after surgery to correct astigmatism and give clear reading vision, but if you don’t have astigmatism, you may be able to put away the glasses indefinitely.
Those who had cataracts removed the old way many years ago were required to wear the old thick cataract glasses following surgery which distorted side vision and the size and shape of objects. Contact lenses became the alternative to thick glasses, but they also had problems with the hassle of taking them out and putting them back in and sometimes the cornea was scratched in the process.
The majority of Medicare patients opt for the Traditional standardprocedure because Medicare and their supplement insurance pay for it. Below is a breakdown of costs for Traditional cataract surgery in the Midwest. I called the billing department of a large eye surgery center located in Kansas, and was told that patients can expect co-pays from $750-$1000 for Traditional surgery which are usually paid by their supplemental insurance. However, for lens implants, the patients will pay cash because Medicare considers these procedures as a luxury and not a medical necessity.
Cost of a Standard Procedure:
Surgeon fee: $2350 for each eye or about $4700
Facility fee: $2380 for each eye or about $4760
Total Charge: $9460
Medicare’s assigned amount for charges: $4730
Note: The average Medicare write off
is about 50%
Facility and Doctor accept
Medicare’s 80% payment: -3784
Amount billed to Supplemental insurance 946
Amt pd by Medigap insurance – 946
Balance due to patient: -0-
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Follow up for prescription glasses and new lenses: Medicare allows a once in a lifetime payment of $118 for the no line (veriflex lenses) and $60.95 for frames.
Coaching tip:
When shopping for new glasses following cataract surgery, ask theprovider if they charge more than what Medicare allows. If so how much more? A client told me that she picked out her new glasses and when she reviewed the bill the provider tacked on an additional $385 in addition to what Medicare allowed.
She went to another provider who accepted the Medicare allowedamount and she paid about $80 total because she wanted some accessories like tinting not allowed by Medicare.
A Medicare beneficiary who has the standard procedure can expectto pay anywhere from $80-100 for glasses depending on what accessories they choose.
WHAT IS THE DIFFERENCE BETWEEN LASIK-IMPLANTS AND INTRAOCULAR LENS PROCEDURES?
Lasik surgery removes tissue from the eye’s cornea to change its shape. Lens implants function like eye glasses or contact lenses and are placed within the eye but the natural lens remains in place. Intraocular lens implants replace the lens.
Intraocular Lens replacement surgery:
A silicone lens is implanted inside the eye to permanently replace the removed cloudy lens. I always thought a cataract was a film or growth over the surface of the eye, but learned that it’s a cloudiness of the lens inside your eye. The cataracts are removed by a method called “phacoemsulsification, not by laser.
Cost of a Lens Implant or Intraocular lens:
Surgeon fee: $2350 for each eye or about $4700
Facility fee: $2380 for each eye or about $4760
Total Charge: $9460
Medicare’s assigned amount for charges: $4730
Note: The average Medicare write
off is about 50%
Facility and Doctor accept Medicare’s
80% payment: -3784
Amount billed to Supplemental insurance 946
Amt pd by Supplement Medigap insurance – 946
Additional upfront charges: Cash required in addition to what Medicare pays:
Total cash payments by patient
prior to surgery $4220
Follow up with Optometrist to
monitor (12 month fee) $ 180
Total out of pocket cash: $4400
Summary:
If you go with the traditional cataract surgery and want the standard lens covered by Medicare insurance, and have a Supplement insurance policy that pays the balance, your total cost could be less than $100 depending on which frames you select following surgery.
If you go with the lifestyle lens implant or intraocular lens, you canexpect to pay about $4400 in cash in addition to what Medicare and your supplement plan will pay.
The added expense of cataract surgery in some cases is just oneexample of why you need to make wise choices with your cash before you are Medicare eligible. You may want to build up a medical savings account in case you’d like to choose the lens implant option if and when those cataracts start to distort your vision.
Those members of our Medicare coaching program who’ve had thelifestyle lens implants tell me that it has changed their life in such a positive way, especially those who no longer need to wear glasses. If you are a candidate for cataract surgery, I hope this medical breakthrough is even more exciting to you than hearing about the landing on Mars.
Coach
