Are cataract surgeries covered under ObamaCare?
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- Cataract surgeries are covered under basic health care insurance policies, as long as the cataract is severe enough to affect your quality of life.
- You may be responsible for a co-pay, and you may have to pay a certain amount until you meet your deductible.
- You do not need a vision insurance plan to get your cataract surgery covered.
If you’ve noticed that your vision isn’t what it used to be, it’s probably time to visit an eye care professional. You may have a cataract in one or both eyes. It’s estimated that over 20 million Americans have at least one cataract, and the good news is that they can be treated through surgery. Cataract surgery is considered medical vision care, so health plans under Obamacare should cover them. To make sure that you have the optimal amount of coverage in case you do have a cataract, you can spend some time comparing your insurance options. Compare health insurance rates now by using our FREE tool above!
Symptoms of Cataracts
The likelihood of cataracts generally increases as people age. A cataract occurs when the lens in your eye gets clouded, making it hard to see clearly. Common symptoms to look out for include:
- Cloudy or blurred vision
- Difficulty seeing at night
- Trouble dealing with glare from lamps, headlights, and sunlight.
What Should You Do First?
If you suspect that you might have a cataract, schedule an appointment with your eye care professional. Your optometrist or ophthalmologist will conduct:
- A visual acuity test to see how well you can see at different distances
- A dilated eye exam to closely inspect your eyes
- A tonometry test to rule out glaucoma
If your doctor determines that you have a cataract that impairs your ability to take part in normal activities, you can discuss surgery.
Is This Initial Visit Covered Under Obamacare?
This first appointment may not be covered by your health plan under ObamaCare. The ObamaCare program does not require vision coverage for adults, so you may be paying for this visit entirely out of pocket.
Some Qualified Health Plans do offer vision coverage at an additional cost. You can also purchase a stand-alone vision plan from a private health insurance provider. The plans vary between providers, and you may be required to pay a small co-pay if you do have this supplemental coverage. Your vision plan may be:
- An Indemnity Plan- This means that you can pick your physicians.
- A Health Maintenance Organization (HMO) plan- This means that you’ll receive care from providers within the HMO.
- A Preferred Provider Organization (PPO) plan- This means that you can receive care at a discounted rate from physicians within your PPO. You can go out of network for an additional cost.
Since plans can differ in terms of coverage and cost, it’s a good idea to explore your choices regarding health insurance.
What Does Surgery Entail?
There are two main types of surgery:
- Phacoemulsification- A doctor makes a small incision on the side of your cornea. Then, a small probe that makes ultrasound waves is inserted into your eye. These waves break up the lens, which is removed by suction.
- Extracapsular surgery- This involves making a longer incision in the cornea. The doctor takes out the damaged part of your lens in one piece and suctions the rest out.
Most people will then have an artificial lens is inserted into their eye. If for some reason, the artificial lens is not a good fit, then they will be given contact lenses or glasses to help them magnify images. Modern technology has allowed doctors to complete most of these surgeries in less than 20 to 30 minutes.
Is Cataract Surgery Covered Under Obamacare?
Most basic insurance policies do cover cataract surgery if your doctor deems it necessary to fix your vision.Those patients insured with Medicare can be eligible to get their surgery covered under Medicare Part B, which applies to doctor’s visits and outpatient care.
What is the Out of Pocket Cost?
Some patients may have zero cost associated with their cataract surgeries. This can be the case if they’ve met their deductibles and have plans with no co-pays for these types of procedures.
Other patients may incur minimal costs if they have not yet met their deductibles and are required to pay co-pays at doctor’s appointments.
Many doctors prefer to schedule at least one follow-up appointment to ensure that everything is healing properly. Cataracts generally worsen over time, so its best to see your doctor as soon as you notice any issues with your vision. If you have a minor cataract, you may be able to treat it with non-surgical methods. These include:
- wearing sunglasses
- reducing the light in your home or office
- adjusting your corrective lenses
If you have a cataract that is significantly affecting your quality of life, you’ll likely be a candidate for surgery. That surgery will be considered part of your medical care, and it will be covered under your insurance plan. You can take some time to go over the details of different insurance policies to ensure that you can select a plan with the ideal amount of coverage. Enter your zip code in our FREE tool below to start comparing health insurance plans now!