The total cost of cataract surgery is typically an accumulation of a number of expenses, including doctor’s visits, facilities charges, anesthesia, supplies and the surgery itself. On average, the total cost of cataract surgery in the United States is $3,000 to $5,000 per eye if you pay for the surgery out-of-pocket. Medicare and health insurance plans can help defray most or even all of these costs, minus deductibles and co-pays when applicable. The cost of cataract surgery can vary greatly, however, depending on where you live, the surgeon you choose and your specific needs.

For example, it costs extra to repair other vision problems like astigmatism at the time of cataract surgery. Additionally, while private health insurance plans and Medicare often cover the cost of traditional, monofocal intraocular lenses (IOLs), many people opt for multifocal (bifocal or trifocal) lenses that allow for corrections in up-close and distance vision. These costs are typically seen as not medically necessary and are often not covered under insurance plans and government programs.

Health Insurance Coverage

Most private health insurance plans (either employer-sponsored or purchased individually) cover the cost of cataract surgery, especially for people age 65 and over. The only amount you would have to cover would be the cost of your annual deductible, as well as any co-pay amount (typically 10-20%).

Additionally, you may have to pay 20% of the following costs that are not a part of the actual procedure, but which are necessary in order to complete the cataract surgery:

• An EKG test that determines your heart health prior to surgery
• A comprehensive eye exam to determine your eye’s refractive errors
• Charges for an anesthesiologist or nurse practitioner
• Prescription eyeglasses, if needed after surgery
• Follow-up procedures or care due to complications that arise after 90 days included post-operative care

Free or Reduced Cataract Surgery with Medicare

Every year, Medicare determines how much allowed value is covered for the cost of cataract surgery. Most cataract surgeons agree not to charge Medicare patients above this amount. In the majority of Medicare cases, the government will cover 80% of the allowed amount, with the patient responsible for the remaining 20% (minus the annual deductible which is $155 as of February 2010).

Supplemental Insurance

Supplemental insurance policies can cover the 20% Medicare co-payment or your private health insurance plans co-pay in order to make the surgery virtually free for patients who carry these plans. There are also government and private subsidy programs available as well that can help defray the cost of the Medicare co-payment and deductible.

Contact our New York office at The Fifth Avenue Eye Center to find out more about cataract surgery and how much you can expect to pay for you procedure. We’ve served countless New York cataract surgery patients and we can help you as well. Our no-obligation, free consultation will help you get questions answered and will present you with options for cataract surgery in New York.