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CATARACT SURGERY AND INSURANCE COVERAGE

August 18, 2022

Is Cataract Surgery Covered By Insurance?

 A Cataract is when the lens in the eye becomes cloudy and hard. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. If the cataract changes vision so much that it interferes with your daily life, the cataract may need to be removed. Surgery is the only way to remove a cataract. You can decide to not have the cataract removed. If you don’t have the surgery, your vision loss from the cataract will continue to get worse. To restore vision, the cloudy lens must be removed and replaced with a new artificial lens called an intraocular lens implant (IOL).  Surgery is the only effective treatment for cataracts. With one in six people over age 40, and more than half of people over age 80 having cataracts, you will be relieved to know that, yes, cataract surgery is generally covered by insurance. At least, most of it. 


Medicare, Medicaid and most private insurance programs deem cataract surgery to be “medically necessary,” assuming the development of the cataracts is such that it interferes with the patient’s normal daily activities. Often, in the early stages of cataract development, your eye doctor will recommend against surgery until the daily impact is evident, and this generally aligns with insurance programs’ guidelines as well.


To be clear, when we talk about insurance covering cataract surgery, we’re referencing your general health insurance plan, not vision-specific insurance. Vision insurance plans are highly unlikely to cover any costs related to cataract surgery.


Insurance plans generally cover the primary costs of cataract surgery, including:

  • Pre-operative eye scan
  • Traditional cataract surgical procedure
  • Monofocal intraocular lens implant
  • Any related medications


Depending on your plan, some diagnostic procedures and pre-surgery treatments may not be covered. Additionally, many advanced intraocular lenses designed to also correct presbyopia or astigmatism are often not covered. Many patients opt to pay for these items out-of-pocket, as they can permanently eliminate the need for eyeglasses.


The specifics of health insurance plans vary, so it’s a good idea to talk with your health insurance provider in advance, so you know exactly what to expect.


If the time is right to restore your vision through cataract surgery, consider Shipp & Wooten Eye Center for your vision care.  Darwin Wooten, M.D., F.A.C.S., John R. Shipp, M.D., Bernard Shipp, M.D., along with their talented medical team, are well-known for their experience, friendliness and results.  Our helpful administrative staff will work with you and your insurance provider to ensure you get the coverage benefits to which you are entitled. 

Contact Shipp & Wooten Eye Center today at 662-286-2020.






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