Does Insurance Cover Cataract Surgery? Costs & Coverage

Does Insurance Help Cover Cataract Surgery?

Cataracts are one of the most common eye conditions among older adults and have affected more than half of all Americans aged 80 or older.¹ If cataract surgery is medically necessary, health insurance plans like Medicare often cover this procedure.² Additionally, some types of vision insurance, such as Aflac supplemental vision insurance (additional coverage to help with expenses not covered by primary insurance), offer benefits for cataract surgery. Let’s explore what you need to know about this surgical procedure, how much it costs, and your insurance options.

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Table of Contents

Key Takeaways

Cataract surgery is usually covered by health insurance plans, such as Medicare, when it’s medically necessary.²
Aflac’s supplemental vision insurance offers benefits for cataract surgery, but our Tier One Dental, Vision and Hearing (DVH) and Group Network Vision plans don’t offer benefits for this procedure.

What is cataract surgery?

Cataract surgery is a corrective eye surgery that removes the lens of the eye and replaces it with an artificial lens called an intraocular lens (IOL).³ This surgery can be required when a patient has cataracts, which occur when the proteins in the lenses of an eye break down and create a cluster, causing cloudy or less colorful vision. The procedure is usually performed by an ophthalmologist and as an outpatient surgery, meaning you can go home after the surgery. It’s a common operation and is generally considered safe.³

How much does cataract surgery cost?

The average cost for cataract surgery with Medicare can range from $380 and $588. Without insurance, you may pay anywhere from $1,906 to $2,943.⁴ Costs vary depending on several factors, including:⁵

Your insurance plan: Medicare has a set fee schedule for cataract removal, but different insurance providers and plans may have varying deductibles or co-payments that influence the final cost.
Type of surgery: There are a few different methods of cataract surgery, including phacoemulsification, extracapsular, intracapsular, and laser surgery, each of which may have different costs or may not be covered by insurance. Likewise, some types of IOLs are more expensive than others.⁶
Location: Areas with higher living costs tend to have higher medical costs due to the higher salaries necessary to pay employees.
Post-surgical complications: In some instances, the artificial lens may become cloudy after the surgery. This is called posterior capsule opacification and may require a follow-up surgery5, which can incur additional fees that may or may not be covered depending on your insurance.

Does health insurance help with cataract surgery?

If you have severe cataracts, surgery may be deemed medically necessary to help avoid vision loss. In this case, private health insurance and public insurance like Medicare and Medicaid typically cover cataract surgery to some extent.5 That said, there are often limitations, such as:

Surgical method or procedure type: Insurers may not cover more expensive procedures, like laser surgery, or require higher out-of-pocket costs for these procedures.⁴
Types of lenses: Some plans may not cover all types of IOLs.²
Severity: Medicare and private insurers may require you to show that your vision acuity has deteriorated to the point of severely interfering with daily activities. Opting for early surgery may cost you more.⁷

Every plan is different, so always review your policy before moving forward with cataract surgery to ensure you’re meeting requirements to get the most coverage possible.

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What does vision insurance help cover?

Aflac offers network vision insurance that is available through your employer. This type of plan offers benefits for several vision care services in and out of network. Aflac supplemental vision insurance, which is also available as a worksite payroll deduction, offers benefits for a range of eye care services, from routine preventative care to vision correcting materials and some major eye care treatment.

Aflac’s Dental, Vision and Hearing Insurance provides three types of insurance collectively in one plan. This plan offers different levels of benefits for vision care within our DVH Core and DVH Elite plans .

Does vision insurance help cover cataract surgery?

Vision insurance may help cover the cost of cataract surgery, depending on the plan. Aflac’s supplemental vision insurance plan offers benefits for cataract surgery. However, our Tier One Dental, Vision and Hearing (DVH) Insurance and Group Network Vision plans don’t cover this surgical procedure. Speak with an Aflac agent to learn more about what is and isn’t covered by our vision insurance plans.

Learn more about vision insurance

Many Americans will experience cataracts at some point in their lives. Private health insurance plans and public programs like Medicare or Medicaid can help with the cost of cataract surgery.

Aflac supplemental vision insurance offers benefits for cataract surgery. This type of policy can also help reduce your out-of-pocket expenses for routine eye care, diagnostic exams, and vision-correcting materials. Chat with an Aflac agent to learn more about our plan options, including network vision insurance, supplemental vision insurance, and DVH insurance.

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