Does Medicaid Cover Cataract Surgery [Get The Facts]

Millions of Americans are having cataract surgery; in fact, more than half of adults over the age of 60 will have or have already undergone this treatment. 

While it is considered a straightforward and successful procedure, it can be fairly costly, which is why we are looking into opportunities where you can rely on Medicaid for financial support.

Is this, however, a guarantee that your cataract surgery will be completely reimbursed by Medicaid?

Continue reading to get all of the fine print information you require. This will assist you in determining the best treatment plan and the most cost-effective solutions. So, without further ado, let’s look at what Medicaid will cover and how it will cover it.

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Medical benefits available under Medicaid

Medicaid was created to assist low-income people and their families with medical expenditures such as emergencies and routine examinations. However, regardless of how fantastic this government program is, certain ambiguous elements leave consumers wondering what is covered and how much.

Don’t worry, you are not alone. 

There are varying regulations and limits since the Medicaid system is established and managed by each state separately. This implies that in certain states, Medicaid will cover practically all medical bills, and in others, there will be greater restrictions.

Contacting the Medicaid office and inquiring about your benefits is the best approach to find out what your country of residency permits. In general, below are a few examples of benefits that are offered in practically every state in the United States:

  • In hospital stays, with exception of mental patients boarding
  • Laboratory and X-rays
  • Out-patient hospital care (in some cases)
  • Regular physician checkups
  • Dental services (with limitations)
  • Some home health services
  • Pregnancy-related care
  • Health screenings for young people (under the age of 21)

The therapies supplied are often deemed medically essential, and because cataracts can be regarded as such a disease, many individuals believe it is fully covered by Medicaid. 

But is this true? Continue reading to learn more.

Does Medicaid Cover Cataract Surgery?

Yes, in certain places, Medicaid will pay a portion of or perhaps the entire cataract surgery if the patient is under the age of 21.

Cataracts or cloudy lenses are more common in elder generations and persons over the age of 60. Cataracts cause hazy and impaired vision, therefore individuals frequently seek solutions to alleviate the symptoms and restore their eyesight.

This can be accomplished by replacing the afflicted lens during the operation, which is typically regarded as a low-risk and simple treatment that completely restores eyesight.

However, depending on a variety of conditions, this procedure can be rather costly, and people are frequently seeking ways to decrease costs and make a smaller co-payment. Medicaid can assist you in this situation.

While coverage varies by state, in most situations, the expenses will be greatly reduced, or if the patient is a child, the costs will be completely covered.

Which Medicaid cataract surgery benefits do you have?

When Medicaid covers cataract surgery, you can expect a variety of benefits depending on where you reside and how old you are.

For people over the age of 21 you can expect:

  • An allowance for eyewear;
  • Contact lenses that will be inserted to treat cataracts;
  • Specialist eye examinations;
  • Reduced co-pays;

When a young person under the age of 21 or a kid has a condition, they will be covered for the following:

  • Routine eye examinations two times per year;
  • Same allowance for eyewear or one frame and two lenses;
  • Replacement for eyewear;
  • All medically necessary vision services.

How much does cataract surgery cost?

Cataract surgery is one of the most expensive procedures, and the final cost will be determined by a variety of factors, including:

  • The type of lenses that have been implanted in your eye;
  • The cost of the doctor doing the operation;
  • Additional hospitalization;
  • Expert consultations, tests, and drugs;

Cataract surgery can range in price from $1.000 to $3.000 per eye, depending on the type of lenses used (intraocular lenses). 

Keep in mind that Medicaid is more likely to cover the less costly choice, and if you want or require the more expensive lenses, you will have to pay for them out of pocket.

How to find out if Medicaid will cover your cataract surgery?

Given the high cost of this procedure, you can be asking how to know for certain if your surgery will be reimbursed (even partially) by Medicaid. 

There are a few methods to check, but the best option is to contact your local Medicaid organization and ask for your state’s laws and regulations.

You can get a lot of useful information, such as:

  • Medical qualification;
  • What do you have coverage for;
  • Information on your Medicaid card, including what to do if you misplace it;
  • How to locate a doctor in your area who is willing to do the procedure;

Keep in mind that Medicaid will fund eye procedures if they are medically required. Because cataracts can impede your life, safety, and comfort, it is one of the operations that is usually authorized.

If your state allows Medicaid to cover certain aspects of the surgery, your co-payment will be significantly less than the total cost of the procedure.

What vision benefits does Medicaid cover in every state?

Vision benefits are optional, and each state has the choice of making them comprehensive or just available in an emergency. However, some benefits are available in all states, such as:

  • The Benefits of Early and Regular Screening, Diagnosis, and Treatment (EPSDT)
  • Medically necessary vision care (treatment for injuries, diseases, and conditions)
  • Medically necessary eye exams

Medicaid will pay or minimize the cost of therapy if the patient is young, pregnant, old, handicapped, or in need of care right away.

Final Thoughts

While we agree that Medicaid restrictions differ from state to state, it’s reassuring to know that patients will always be covered for medically essential procedures. Children and pregnant women are always at the top of the priority list, but all adults can rely on Medicaid for financial support when the circumstance calls for it.

Cataract surgery is no exception; however, bear in mind that you must confirm all specifics with your Medicaid agency or health insurance provider before scheduling an appointment.

David Duford
Author: David Duford