How Much Does Cataract Surgery Cost?

Cataract surgery is one of the most commonly performed eye surgeries in the United States, but it can be expensive if it is not covered by insurance. Without private insurance or Medicare, you can expect an out-of-pocket expense anywhere from $3,000 to $6,000 per eye.

With insurance or Medicare, traditional monofocal cataract surgery is covered, but you may incur expenses in copayments, medication costs, and meeting your annual deductible. Specific costs will vary depending on the type of lens, any additional underlying eye issues, and the surgical technique.

Openly discussing this with your surgeon before scheduling your surgery is imperative to avoid any hidden costs. It is also helpful to speak to your insurance or Medicare representative to fully understand your coverage.

This article will cover a breakdown of the costs associated with specific lenses, surgical techniques, and underlying eye conditions.

What Is Cataract Surgery?

Cataract surgery is a surgical eye operation performed by an ophthalmologist to remove your eye’s lens when it is cloudy. A normal, healthy lens is clear, while one that is damaged is cloudy in appearance. During surgery, your damaged natural lens is removed and replaced with a clear artificial lens.

Cataracts are usually caused by the aging of the crystalline lens. There is a gradual accumulation of yellow-brown pigment within the lens and changes in the structure of the lens fibers with age. This reduces light transmission, ultimately causing a cataract.

Average Cost

Cataract surgery is covered by insurance and Medicare, but specific costs will vary depending on your surgeon, the lens used, and surgical technique. You will have some out-of-pocket expenses with copayments, deductibles, and medications.

Without insurance, the cost of cataract surgery on both eyes is upwards of $6,000 to $12,000. Most surgeons will offer payment plans if you have to pay out of pocket. You can use a health savings account (HSA) to pay out-of-pocket expenses. Furthermore, credit cards do offer interest reductions for specific medical costs. Reach out to your credit card company to see if you qualify.

Specifically, the total cost of cataract treatment for a patient who doesn’t have an insurance provider can range from:

• $3,000 to $5,000 per eye for standard cataract surgery
• $4,000 to $6,000 per eye for laser-assisted cataract surgery or procedures using advanced lens implants

The cost includes the surgery, implantation, and consumable surgery equipment, as well as technical, professional, and surgery center fees.

Type of Procedure

Four main surgical techniques are used for cataract surgery. Phacoemulsification is the most common technique used to remove a cataract. This is utilized during a standard cataract procedure and is covered by private insurance and Medicare.

In phacoemulsification, an ultrasound device is placed through an incision in the eye. It emits highly focused sound waves to break the cloudy lens into tiny pieces. The broken pieces are removed using gentle suction, and an artificial lens is inserted into the capsule.

Extracapsular cataract extraction is a less commonly used technique and involves the surgeon making a larger incision in the eye to remove the lens in one piece. Once the lens is removed, a new lens is inserted. The incision is closed with sutures or stitches.

Intracapsular cataract surgery involves removing the entire lens and capsule through a large incision. This surgery is very rarely performed. This technique may result in more complications and slower healing than surgeries that involve a smaller incision.

Laser-assisted cataract surgery involves using optical coherence tomography. Laser cataract surgery is the newest technique and is generally not covered 100% by private insurance or Medicare. Because it is newer to the market, there are not as many surgeons specially trained in this technique.

Specific laser incisions are made in the cornea and the capsule. The laser then softens the cataract and breaks it up into small pieces. The pieces are removed, and a new lens is placed. Laser cataract surgery can also simultaneously correct an eye condition called astigmatism.

Type of Lens Implanted

There are multiple options for lenses. The most widely used are fixed-focus monofocal lenses, accommodating monofocal lenses, toric lenses (which correct astigmatism), and multifocal lenses (which correct presbyopia).

Private insurance and Medicare typically cover monofocal lenses, but each toric lens will cost about $1,500, and specialized lenses will cost about $3,000 apiece.

Specific specialized lenses such as presbyopia lenses and astigmatism lenses will have additional costs such as:

• Presbyopia lenses with cataract removal: $3,250 per eye
• Astigmatism lenses with cataract removal: $2,150 per eye

Other Underlying Eye Conditions

During cataract surgery, astigmatism can also be fixed. If you have this combination procedure, then a special intraocular lens called a toric lens must be used. The severity of preoperative astigmatism will determine whether it can be corrected completely or you will still need glasses after the procedure.

Utilizing a special toric lens will add additional costs to your procedure that your personal insurance or Medicare might not cover. Specific costs will depend on the surgeon and their billing costs.

It is important to discuss with your healthcare provider potential out-of-pocket costs for the procedure. Unfortunately, if you have astigmatism and a cataract, only one lens can be implanted. Cataract surgery with toric IOLs comes with an added cost of approximately $1,300.

Personal Insurance

All major private insurances cover cataract surgery. Most insurances will cover traditional monofocal lens implants; however, if you are interested in a multifocal lens implant, there may be out-of-pocket expenses. These expenses will depend on your insurance.

Expect to have a copay and a deductible. A copay will apply to the surgery as well as all appointments. There is typically only one copay for the surgery itself, but additional fees for the surgical center and anesthesia group might be required. Your deductible fee will depend on if you have met your annual deductible before the procedure and the cost of the deductible.

Before surgery, speak to your insurance provider and ask questions regarding the financial aspects of the surgery. Some questions to ask might be:

• How much is my copay?
• Is anesthesia covered?
• Is the surgical center covered?
• Is the anesthesia group at the surgery center covered?
• Do I need a pre-approval?
• Is there a specific surgeon I need to use?
• Are postoperative appointments covered?
• Are post-surgery medications used?

Medicare

Cataract surgery falls under Medicare Part B since it is usually an outpatient procedure. Medicare Part B covers doctors’ services and outpatient procedures, and it comes with a monthly premium within the $100-$135 range.

Medicare covers the cost for removing the cataract, monofocal lens implants, and one set of prescription contact lenses or eyeglasses following surgery. This is considered standard cataract surgery. Medicare covers about 80% of the cost. You would cover the remaining 20% after meeting the deductible.

If you are not sure about your exact Medicare coverage and available options, speak to a Medicare representative before cataract surgery. If you are interested in eliminating the use of glasses or contact lenses after the procedure, there may be additional costs to upgrade to a different artificial lens.

It is important to discuss your Medicare coverage with your surgeon to know what technique they will be doing so there will be no payment surprises.

Flexible or Health Spending Account

A flexible spending account (FSA) is a special account you put money into that you use to pay for certain out-of-pocket healthcare costs, including surgery and medications. You will contribute money from your paycheck before income taxes are taken out.

This means the money in the FSA is not subject to taxes. Some employers may contribute to an employee FSA; however, it is not required.

You can use your FSA for the insurance deductible, copayments, and qualified medications. By utilizing pre-tax money, you will be saving money. You will be given either a debit card to pay for medical expenses, or you will have to submit receipts and documentation for reimbursement.

Outcomes

Determining which surgical technique and lens are best for you depends on your goals after surgery. If you are OK wearing glasses or contact lenses, then undergoing standard cataract surgery using a monofocal lens would be a good option. This surgery is covered by both private insurance and Medicare, less a copayment and deductible.

If you do not want to wear contacts, then upgrading to a different lens or a more advanced surgical approach may incur additional out-of-pocket costs.

Knowing your financial abilities is important when discussing surgical options with your healthcare provider. If you have the ability to pay more money out of pocket, then there may be additional options available to you. If you do not have financial freedom regarding the surgery, the standard cataract procedure is extremely safe and effective.

Just because a specific technique or lens costs more money does not mean that it is a better approach or product. Depending on your eye condition, you may need something different than the standard cataract procedure. There may not be any other options. If that is the case, speak to your surgeon and the insurance company to determine specific out-of-pocket expenses.

Cost and coverage isn’t the only factor in determining which type of cataract surgery would be a good fit. It is important to look at the complication risk and surgical outcomes. Studies published in 2020 found similar outcomes for laser-assisted cataract surgery and phacoemulsification:

• A randomized study of 907 patients found no significant difference in the success rate between the femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification cataract surgery (PCS) research groups despite the differences in cost and procedure technique.
• A Johns Hopkins University randomized study of 55 cataract surgery patients found no difference between surgical and visual outcomes for these two types of surgery.

Professionals try to get as close to perfection as possible. But there are always risks to surgery, and therefore outcomes can never be guaranteed, no matter which lens is used or whether insurance covers or does not cover the procedure.

A Word From Verywell

Cataract surgery is needed to help restore vision and is not considered elective. The procedure has minimal risk and side effects. With that being said, it is important to discuss with your surgeon which surgical technique will be used.

It is an expensive surgery; however, it is covered by insurance and Medicare. Speak to your insurance company as well as the surgeon’s office to determine out-of-pocket costs.