Understanding Insurance: What Does Cataract Surgery Cost?

February 23, 2024


When considering cataract surgery, it can help to understand the overall costs. The cost of cataract surgery can vary for many reasons.

OOMC is here to break down the average costs of cataract surgery and some important questions to ask your insurance company and providers when preparing for eye care.

Average Cost of Cataract Surgery

Payment being madeIn the United States, cataract surgery costs between $3,500 and $7,000 per eye, without insurance.

Insurance—including Medicare—often reduces those overall expenses. The exact costs of your cataract surgeries will depend on your insurance.

Medicare can cover up to 80% of cataract surgeries, while the patient would be responsible for the remaining 20%.

You can find out how much cataract surgery costs through your insurance provider.

Factors That Affect Cataract Surgery Cost

Several factors can affect the cost of cataract surgery, including:

  • In-network or out-of-network providers
  • Location
  • Type of lens used during cataract surgery

One of the most important factors is whether your provider is in network. This is something you can check, with your insurance company.

Your insurance company may have policies that do or do not cover specific providers and can increase the cost of your cataract surgery.

Where you have surgery can also change the costs. An outpatient procedure at a hospital may cost more than one at an ambulatory surgical center.

During cataract surgery, the doctor will implant a lens. The type of lens that works best for you can affect the overall cost of your surgery and is something you should discuss, with your provider.

Monofocal lenses are generally less expensive and allow you to see better at one distance—near or far.

Toric lenses are available and allow you to see better at a distance, as well as correct for astigmatism.

Multifocal lenses are also available and allow you to see at various distances. Your eye doctor will recommend the right option for you.

Questions To Ask Your Insurance Company and Provider

Calling InsurancePreparing for your cataract surgery and its associated costs can raise some questions to ask your provider and your insurance company.

These questions can ensure you have a better understanding of what’ll be covered and the estimated total costs.

Contacting your insurance company is a good way to get an accurate estimate and clarify with them if your cataract surgery is covered. Consider the following questions:

  • Do I need prior authorization for cataract surgery?
  • How much is my co-pay or deductible for cataract surgery?
  • Is my provider considered in-network?
  • Is the clinic or surgery center in-network?
  • What costs will insurance cover for cataract surgery?

Your provider’s office can also provide an estimate and help you understand the costs associated with after-care, such as post-op appointments and medication.

Questions to ask your provider’s office can include the following:

  • What costs am I responsible for?
  • Are presurgical and postsurgical care included in the overall cost of surgery?

Learn More About Cataract Surgery Costs and Options

Are you ready to get care for your cataracts? Contact a local OOMC practice to schedule an appointment and explore your treatment options.

We’ll work with your current doctor to create an individualized plan that meets your needs. Reach out to a local OOMC provider today.

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