Does Obamacare cover cataract surgery?

Asked by: Rosalee Kihn  |  Last update: February 11, 2022
Score: 4.5/5 (38 votes)

Under Obamacare, health plans offered on the exchanges must cover medical vision care like cataract surgery. They also have to pay for eye exams and glasses for children.

Are cataracts covered by Obamacare?

Serious eye conditions: Care for medical eye conditions such as cataracts, glaucoma, or macular degeneration will not be supported by your vision plan. However, they are usually covered under your Obamacare medical insurance plan.

What insurance covers cataract surgery?

Since cataract surgery is considered a medically necessary procedure, the cost of cataract surgery is largely covered by private insurance or Medicare, the latter of which covers most patients. Medicare is the U.S. federal health insurance program that covers people aged 65 and older.

Are cataracts considered a pre existing condition?

Generally high blood pressure, diabetes, heart disease, AIDS, pregnancy, cancer, cataract etc. would be considered pre-existing conditions as it would not have occurred overnight after buying the insurance plan.

Does Obamacare have vision coverage?

ACA Marketplace health plans do not have to offer vision coverage to adults, but adults can get vision coverage on the federal exchange as part of their major medical plan if it's included in a plan's benefits. Stand-alone vision insurance plans are not available directly from the federal or state marketplaces.

Does Medicare Cover Cataract Surgery?

15 related questions found

Does health insurance cover eye surgery?

Health insurance usually doesn't cover the cost of refractive or laser eye surgery, but some companies will pay the bill if certain criteria are met. Some insurance companies offer a vision plan which may provide a discounted price or apparent partial coverage for laser eye surgery.

How much do glasses cost without insurance?

The average cost of glasses without insurance is $242, according to statistics from VSP. That's for frames only. For basic, single lenses, it's $113. That means the total will run you on average about $351 for a complete pair of glasses if you don't have vision insurance.

Are pre-existing conditions covered in 2021?

Yes. Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

Can you be denied coverage for a pre-existing condition?

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.

Is high blood pressure considered a preexisting condition?

Other Types of Pre-existing Conditions

Hypertension (high blood pressure) is an example of one such common pre-existing condition affecting more than 33 million adults under 65.

How much should I expect to pay for cataract surgery?

On average though, you can plan on your cataract surgery costing around $3,500 to $3,900 per eye before insurance. With insurance, the cost will vary slightly depending on your provider, but generally, the out of pocket costs are nominal.

Why is cataract surgery not covered by insurance?

It needs to be causing a problem to make it medically necessary to remove it. Medicare and most other insurance do not cover refractive surgery (Lasik, PRK etc. ) at all. The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY.

Who pays for cataract surgery?

Yes, basic cataract surgery is covered by Medicare. Your doctor or ophthalmologist must determine that the surgery is medically necessary for your health. Medicare typically covers 80 percent of expenses related to cataract surgery. It also covers one pair of eyeglasses or contact lenses after the eye surgery.

How do you qualify for cataract surgery?

Cataract surgery is considered “medically necessary” by some insurance companies (like Medicare) only when certain conditions are met. The service is often covered only after a cataract has caused visual acuity to be reduced to below 20/40 — the legal vision requirement for driving in most states.

Does United Health Care cover cataract surgery?

Cataract surgery and most related diagnostic tests are covered by United Healthcare. ... Since Medicare doesn't cover premium IOLs, neither does United Healthcare. This includes both presbyopia-correcting IOLs (ReSTOR and Tecnis) and astigmatism-correcting IOLs (toric).

What makes cataract surgery medically necessary?

In basic terms, cataract surgery is considered medically necessary when the cataracts caused significant vision impairment. In these cases, the vision loss is too severe to be addressed through less invasive means, such as corrective lenses and assertive devices.

Is the Affordable Care Act still in effect?

The Rest of the ACA Remains in Effect

Other than the individual mandate penalty repeal (and the repeal of a few of the ACA's taxes, including the Cadillac Tax), the ACA is still fully in effect.

What happens if you don't have health insurance and you go to the hospital?

However, if you don't have health insurance, you will be billed for all medical services, which may include doctor fees, hospital and medical costs, and specialists' payments. Without an insurer to absorb some or even most of those costs, the bills can increase exponentially.

What's considered a pre-existing condition?

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.

How long can a pre-existing condition be excluded?

A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for a late enrollee).

What is the cheapest way to buy prescription glasses?

Where to Buy Affordable Eyeglasses
  • Limited time offer: Save 65% off frames for eyeglasses and sunglasses with basic Rx lenses + Free shipping to your doorstep. ...
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  • 39DollarGlasses.

What is the average cost of a pair of bifocal glasses?

The cost of glasses can range anywhere between $8 and $600 for a standard pair — and can climb into the thousands for name brands. The average price for new glasses is about $195. You can shop around for the best price if you don't have insurance to help pay for them.

Does GoodRx work for glasses?

Get prescription discounts on your medications through GoodRx, and save on prescription eyeglasses, sunglasses and contact lenses through AAA optical partner LensCrafters. Stay healthy, see clearly and enjoy the many benefits of AAA membership.

Does Oscar cover cataract surgery?

Elective procedures (such as cosmetic surgery or in vitro fertilization) are planned in advance and usually don't involve a medical emergency. Some plans do cover some elective surgeries like cataract surgery or ear tubes, while some don't.