Does VSP Cover Cataract Surgery? – NVISION Eye Centers (2024)

FAQs

Does VSP Cover Cataract Surgery? – NVISION Eye Centers? ›

VSP does not cover cataract surgery. VSP is a vision insurance company that provides a range of services such as: regular eye exams, prescription glasses, and contact lenses. The company, however, does not cover cataract surgery.

Vision insurance does not cover cataract surgery, even though your vision is involved. Instead, it's used to lower the costs of routine eye care like eye exams and prescription glasses or contact lenses.

Answer: Insurance companies have criteria that determine when an ophthalmologist can remove a cataract. While the main criteria is best-corrected visual acuity of 20/40 or worse, other parameters such as debilitating glare or double vision can allow for a cataract to be removed in special circ*mstances.

$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.

If you choose to upgrade to a multifocal intraocular lens or other advanced technology IOL, you will need to pay the extra costs associated with these premium lenses with your own money. This added "out-of-pocket" expense for advanced cataract surgery can range from $1,500 to $4,000.

The VA also provides more advanced care when needed; qualified veterans can receive cataract and glaucoma surgery, and veterans experiencing vision loss have access to rehabilitative services. Eligibility for vision care services through the VA is determined on an individual basis.

How To Get Free Glasses After Cataract Surgery. If the patient has Medicare, Medicare Advantage plan (Medicare Part C), or Medicaid services coverage, they might be able to receive new glasses for free after surgery. Medicare Part B coverage handles the cost of glasses in many Medicare insurance plans.

MEDICAL NECESSITY

Concomitant intraocular disease (e.g., diabetic retinopathy or intraocular tumor) requiring monitoring or treatment that is prevented by the presence of cataract. Lens-induced disease threatening vision or ocular health (including, but not limited to, phacomorphic or phacolytic glaucoma).

Who needs cataract surgery? Your eye doctor will probably suggest cataract surgery if you have vision loss that gets in the way of everyday activities like reading, driving, or watching TV. Your doctor might also recommend surgery even if your cataracts aren't the main cause of your vision problems.

There is no way to cure or get rid of cataracts once they've formed besides cataract surgery. No medication can eliminate existing cataracts, and no eyewear can completely counteract their effects. Some ophthalmologists are seeking nonsurgical solutions, but at this time, no other solution has been found.

What is average out of pocket cost for cataract surgery with Medicare? ›

Average cataract surgery costs vary depending on the source. Medicare, which bases national averages on 2022 payments, indicates the average cost ranges between $1,808 and $2,866 per eye, depending on which type of care facility performs the procedure.

On average, the cost of eye drops after cataract surgery ranges from $45 to $200 or more. It's important to check with your local pharmacy or eye care provider to get the most up-to-date pricing information based on your location.

See Clearly Without Glasses With Premium Lenses

You will be able to see things far away clearly, but you will need to wear glasses for near activities, such as reading, writing, or sewing. The main reason that most people upgrade to premium lenses is for greater flexibility with their vision in their day-to-day lives.

While monofocal lenses provide focus at one distance only, multifocal lenses allow for vision at a range of distances, meaning they can correct both near, intermediate, and far distances. These are a more popular option for those who want to also eliminate their dependency on glasses.

For example, there is some loss of clarity and contrast with multifocal lenses, which can present a problem with night vision. Some patients also experience a glare or halo. In addition, you won't achieve 20/20 vision with multifocal lenses and may require additional vision correction solutions.

If someone has an ocular comorbidity in either eye (eg, severe dry eye disease, irregular astigmatism, epiretinal membranes, macular degeneration), he or she is not eligible for a multifocal IOL. In my practice, this means that 50% of patients are ineligible.

If a prescription change is found (minimum ±0.50 diopter), we'll cover replacement lenses, including any lens enhancements on your original pair*.

Cataract surgery is eligible with a flexible spending account (FSA), health savings account (HSA), health reimbursem*nt arrangement (HRA) or a limited-purpose flexible spending account (LPFSA).

RLE is most often considered an elective procedure, so it's typically not covered by insurance. Depending on your plan type and coverage details, it may be covered when deemed medically necessary, such as in cases of severe vision loss or retinal detachment.

If the rule is finalized as is, reimbursem*nt for cataract surgery (CPT code 66984) will be reduced from $654.47 to $557.58—a 15% cut in payment with no changes in the requirements or costs of the procedure.