How much does cataract surgery cost in 2021? | finder.com

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How much does cataract surgery cost?

Compare payment options and costs for cataract surgery

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If you're a candidate for cataract surgery, costs vary significantly based on your insurance, where you live and the hospital or doctor you choose. Each procedure is assigned standardized, 5-digit CPT codes that hospitals and insurance companies use for billing purposes. Use the CPT code to compare prices for cataract surgery before scheduling your appointment.

Average cost for cataract surgery

If you have health insurance and use an in-network doctor, you can expect to pay $4,678 for cataract surgery on average. If you don't have insurance or you choose an out-of-network doctor, the cost increases to $9,741.

Average costs are based on the primary cost of cataract surgery in the 90201 ZIP code and don't factor in insurance costs like copays or deductibles, or additional fees often charged by doctors or hospitals — like medical supplies, facility fees and support services.

CPT code Procedure ZIP used Description In network total costs Out of network total costs
66821 Cataract surgery 90201 Removal of recurring cataract in lens capsule using laser $4,678 $9,741

Related costs for cataract surgery

CPT code Primary procedure Description In network cost Out of network cost
66821 Hospital (outpatient) Hospital outpatient facility (HOSPF) estimate for procedure code 66821 (in addition to your doctor's fee) $3,667 $7,019
Total primary & related costs $3,667 $7,019

Does health insurance cover cataract surgery?

Most health insurance policies cover cataract surgery if it's medically necessary and you've met your deductible and any coinsurance or copays specified in your policy. If you don't have health insurance, you may need to pay the full cost of cataract surgery out of pocket. The exact amount your insurance pays for cataract surgery comes down to your plan and the doctor or healthcare facility you're going to. For the most accurate idea of how much you'll pay out of pocket, contact your insurance company before booking cataract surgery.

Does Medicare cover cataract surgery?

It depends on your Medicare plan, but generally Medicare covers procedures like cataract surgery that are considered medically necessary by your doctor.

  • Medicare Part A (Hospital Insurance) covers inpatient care in a hospital or skilled nursing facility following a hospital stay, so it typically won't cover cataract surgery.
  • Medicare Part B (Medical Insurance) pays for emergency, urgent and outpatient care and some preventative services, which means Medicare likely covers cataract surgery — but you'll be charged a 20% coinsurance.
  • Medicare Part C (Medicare Advantage) is a comprehensive plan that combines Part A, Part B and often Part D and should pay for a portion of cataract surgery minus any deductible, copay or coinsurance.
  • Medicare Part D (Prescription Drugs) won't cover cataract surgery, but it may help to pay for any medication you need as part of your recovery.

What affects the cost of cataract surgery?

The price you'll pay for cataract surgery varies based on factors like:

  • Your health insurance plan. Your coinsurance, copay and how much of your deductible you've met affects the amount you pay for cataract surgery out of pocket, does as whether your doctor or anyone else involved is outside your network.
  • Your location. Where you live dictates which doctors or healthcare facilities you have access to for cataract surgery. Urban areas are more competitive, which can drive down costs for cataract surgery compared to rural areas.
  • Your doctor. Your doctor's experience and expertise affects how much they charge for cataract surgery. And the cost may increase if complications arise during cataract surgery and your doctor has to call in other medical professionals.
  • Additional fees. Your healthcare provider may charge associated fees that increase the overall cost of cataract surgery.

How to cut your costs for cataract surgery

In the leadup to cataract surgery, confirm your copay, coinsurance and deductible with your insurer so you know how much you'll pay out of pocket.

  • Dip into your HSA, FSA or HRA. These tax-advantaged accounts can help you to cover out-of-pocket costs for cataract surgery.
  • Ask about financial aid. If you can't afford to pay the average cost of $4,678 with or without insurance, most hospitals and clinics offer financial aid programs that include discounts or interest-free payment plans.
  • Explore outpatient centers. Outpatient facilities tend to charge less for medical procedures like cataract surgery, though they're not an option for everyone.
  • Consider medical loans. A medical loan could help pay for anything your health insurance doesn't cover for cataract surgery, like copays or coinsurance.
  • Compare doctors and hospitals. Lower the price of medical services by comparing in-network hospitals before you schedule cataract surgery. The Centers for Medicare and Medicaid Services require hospitals and clinics to publish online price lists for common procedures, which may include costs for cataract surgery.

Bottom line

The price of cataract surgery is a major consideration for treatment whether you have health insurance or not. The amount you'll pay for cataract surgery can vary between doctors, hospitals, locations and insurance plans, which is why it's worth comparing hospital prices.

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