Cataracts affect nearly 20.5 million Americans over the age of 40, which is approximately 17% of the U.S. population. More than 6 million people in this age group have had cataract surgery, which is one of the safest and most effective surgeries in the United States.
Cataracts occur when the lens of the eye becomes cloudy and obscures vision. During surgery, the clouded lens is removed and replaced with an artificial intraocular lens, or IOL, to restore vision. We’ve researched a variety of sites to determine what the average costs are for cataract surgery. The following is a summary of what we found.
The cost of cataract surgery ranges from $3,090 to $3,726 for a basic single eye lens replacement at an outpatient facility. The average cost across the nation is $3,300 consisting of $1,233 in physician’s fees, $1,669 in facility charges and $398 for anesthesia.
Fees vary by the type of procedure and the type of lens implanted. Those opting for the newer high tech lenses for presbyopia will find costs increasing to an average of $4,269 per eye.
Out of Pocket Costs
Both Medicare and private insurance cover the cost of a traditional cataract surgery as deemed medically necessary. Implantation of a monofocal IOL is medically necessary since vision cannot occur without a lens. Implantation of lenses for presbyopia, however, is not generally covered since reading glasses can correct near vision. Insurance will only cover the cost of a monofocal IOL, with the rest subject to out of pocket expense. The additional expense can be as much as $1,979 per eye. Reading glasses are also considered an out of pocket expense unless the patient carries vision insurance which helps cover the cost of the glasses.
Other out of pocket costs include:
- Preoperative testing, such as lab work and electrocardiograms (EKGs).
- A complete eye exam which makes precise measurements of the eye to size the IOL.
- Anesthesia copayment.
- Additional care for any surgical complications beyond the standard 90 days of follow up care.
Often, insurance will cover some of the pre or postoperative care, such as the eye exam or testing. Postoperative surgical visits are covered in the surgeon’s fee and should not be billed out separately.
Premium Itraocular Lenses
Premium IOL’s are treated like LASIK with regard to insurance; both are elective procedures. IOL’s to correct presbyopia or astigmatism are considered elective, despite the fact that they virtually eliminate the need for corrective lenses. Since they are elective, patients should contact the surgeon’s billing office to get a written statement of all expenses, since there are no rules that govern costs.
Basics of Cataract Surgery
Cataract surgery is relatively simple. Lasting about 15 minutes with the use of local or light anesthesia, the clouded lens is removed by a procedure called phacoemulsification, or phaco, which breaks up the lens using high frequency ultrasound. Then a gentle suction is used to remove the lens from the eye. The IOL is implanted behind the iris and pupil which hold the IOL in place. The tiny incisions are then closed. The use of a smaller incision in phaco allows the eye to heal faster and decrease the risk of complications.
Patients should expect to stay at the outpatient facility approximately 90 minutes and will need a driver. Patients will be sent home with prescription eye drops to help prevent infection, an eye shield and wraparound sunglasses to prevent UV damage to the eye post-op. The eye shield must be worn while sleeping and napping for the period determined by the surgeon.
Cataract surgery improves vision and allows patients to regain their independence. The surgery is safe and basic implants are covered by insurance. Patients wanting to eliminate their need for glasses have many options, but the costs of the lenses are not covered by insurance.