Cataract surgery is one of the most common surgeries in the United States, with an average of 3.7 million cases per year in the United States, 7 million in Europe and 20 million worldwide, according to the National Institutes of Health. How much does it cost?
What you will pay can vary widely, depending on several factors — including your insurance, the place where the surgery is performed and — especially — what kind of artificial lens is used to replace the one the surgeon removes.
Cataracts develop naturally, with the lens becoming cloudy. “In most people, cataracts start developing around age 60, and the average age for cataract surgery in the United States is 73,” Associated Eyecare writes on its site. The symptoms include a change in the perception of colors, a lot of glare from headlights at night, or a change in glasses prescriptions.
The surgery is often quick, taking about 10 to 20 minutes or so. The surgeon removes the clouded lens with the cataract, and replaces it with a new intraocular lens (IOL), which is about a quarter of an inch wide. The anesthesia is often sedation or twilight — the medications versed and fentanyl are a common combination. Often the anesthesia is done by a nurse anesthetist, not a full M.D. anesthesiologist.
How much does cataract surgery cost?
The Vision Center says on its site; “The average cost of cataract surgery in the U.S. is between $3,500 and $7,000 per eye for someone without insurance. However, Medicare and private insurance plans often cover all or a portion of the costs.”
Humana says on its site: “Without private insurance or Medicare, the out-of-pocket expense for cataract surgery can range from $3,000 to $6,000 per eye. Specific costs can vary depending on your surgeon, surgical technique and other fees.”
“Although Original Medicare doesn’t cover routine vision care, it does help pay for cataract surgery if it’s done using traditional surgical techniques or lasers.This is through Medicare Part B, the medical insurance portion of Original Medicare. …
“Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees.
“Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). Your Part B benefits may also pay for 1 pair of prescription eyeglasses with standard frames or a set of contact lenses.”
If you have Medigap insurance (Part G or Part F), that may cover the 20 percent that is not covered by Part B.
What about the cost of the lens?
While much or all of standard cataract surgery is often covered by insurance, the cost of the replacement intraocular lens (IOL) can result in a surprise bill.
Monofocal IOL’s, the standard or plain-vanilla lenses, are typically covered by Medicare. But a different lens might be recommended. If you want premium IOLs, you will probably have to pay the difference.
For example, an astigmatism-correcting intraocular lens (A-C IOL) might be offered, to let a person with astigmatism see without glasses or contacts. A friend got these, called toric lenses, and she paid $850 per eye; if she had not gotten the intraocular toric lenses, she might have had to use toric contact lenses to correct her astigmatism.
There are also presbyopia-correcting intraocular lenses (P-C IOL) which correct for the problem older people experience when their lens becomes rigid and less able to focus on things up close. So that replacement lens might also correct the up-close vision problem that reading glasses correct, letting you go without reading glasses after cataract surgery.
Then there are multifocal intraocular lens implants that can correct several problems, in addition to replacing the initial lens. These lenses are generally described as refractive (generally providing good far and intermediate vision, though perhaps less good near vision), diffractive (good for far and near, though perhaps less good on intermediate vision) or combined.
Do you need a different lens?
Dr. Ara Aprahamian, who does cataract surgery, laser vision correction surgery and other eye care at the Gailey Eye Clinic in Bloomington, Ill., explained that sometimes the standard IOL is the best choice: The patient and doctor must carefully consider the options, he said. If not, disasters may result – and the patient is left having paid extra for a lens upgrade, but with significantly worse vision problems.
“The toric may not be appropriate for certain health conditions,” he said in a phone interview. “But the multifocal is the one that’s definitely more prone to abuse. It’s the fussiest one — it divides the incoming light into far- and near-focus light. The lens itself has a series of concentric rings that focus light at different distances, sort of. Depending on the size of the pupil, you’re able to concentrate on the image that’s clearest.
“When you are reading, three things happen: your eyes converge, so they come closer together; your natural lens would focus if you had a natural lens; and your pupil shrinks. So when the pupil shrinks, it concentrates the light beams through the central reading portion of the lens. In a healthy eye, we wouldn’t expect the quality of the vision to be affected significantly by the slight splitting that happens.
“But in an unhealthy eye, say for a patient with glaucoma, or macular degeneration — those are two of the most common eye diseases that lead to blindness United States — their quality of vision can be negatively affected by having a multifocal lens. It affects what’s called contrast sensitivity.
“There are dozens of other eye conditions that should preclude a patient getting multifocal lenses. There’s a corneal condition called keratoconus, where the cornea is warped. If you have a warped cornea, your images aren’t going to be clear, and splitting the light makes it even worse. If you’ve had a stroke of the eye or a stroke of the brain that affects the vision, then your peripheral vision is limited. You should not have a multifocal lens.
“I just saw a patient for a second opinion, who had their surgery done by another surgeon who did this very same thing. He implanted a multifocal in a patient with keratoconus. She didn’t have any insurance, so her surgery cost upwards of $10,000. She speaks maybe a few words of English — her son was there translating — so it just feels like he took advantage of her. And then he tried to fix it by doing these other procedures that didn’t work. Then she came to me saying ‘I can’t see.'”
Dr. Aprahamian suggested that people understand that not everyone is a good candidate for upgraded lens implants. Armed with this information, you can ask your doctor: “Are my eyes healthy enough for this lens?” For further research, Dr. Aprahamian suggested the American Academy of Ophthalmology website’s page on intraocular lenses.
Here’s a video on cataract surgery and lenses that we found on the Reddit subreddit r/CataractSurgery. The surgeon is Dr. Uday Devgan from DevganEye in Beverly Hills, Calif., and it got good marks from two eye surgeons we talked to. The Reddit moderators had pinned it to the top of the feed, praising it as a useful video. It runs about 15 minutes.
How much do lenses cost?
We have several reports that the toric lenses are less than $1,000 per eye, including the friend mentioned above, who lives in Iowa. But there is not an actual price sheet that we could find anywhere. One of our ophthalmologist friends said “the market sets the price,” which means that it can be hard to find out — and also that you’ll be in the awkward position patients are often in in the U.S. healthcare system, when you get a price and don’t know if it’s high or low, negotiable or not. There is no actual price regulation in healthcare generally, which makes the task of finding out “what does this cost?” a challenge. (That’s why we’re here, by the way.)
So here are some resources.
Higher cost-of-living areas are likely to have higher prices.
“Private insurance and Medicare typically cover monofocal lenses, but each toric lens will start at about $1,500, and specialized lenses will start at about $3,000 apiece. Specific specialized lenses such as presbyopia lenses and astigmatism lenses will have additional costs.” SightMD, a chain in New Jersey, New York and Pennsylvania.
“The cost of intraocular lenses can vary by doctor and by location. As a result, it’s difficult to quote a “one size fits all” price for it. In 2017, the average cost for a premium intraocular implant was $1,415 per eye.” EyeHealth Partners, Alabama and Tennessee.
“With IOLs, the two basic categories are refractive IOLs to correct presbyopia and premium or toric IOLs to correct astigmatism. Cataract surgery with toric IOLs comes with an added cost of approximately $1,300. The average cost of refractive IOLs is around $2,100.” DFWEyes, Dallas-Fort Worth.
“Premium refractive IOLs generally cost around $2,500 per lens, while toric IOLs can cost around $1,500 per lens. A standard monofocal IOL will cost significantly less and often be covered by insurance. … Technology: The type of technology used can also impact cost with laser-assisted cataract surgery, often increasing costs by at least $1,500 per eye.” MyVision.org, Aliso Viejo, Calif.
In London, one practice, OCL Vision, offers financing, with a basic monofocal lens costing £2,500 (British pounds) per eye, which is $3,087 at the current exchange rate, and multifocal, trifocal or extended-range lenses starting at £3,600 (British pounds) per eye, which is $4,445 at the current exchange rate.
At Arizona Cataract, it’s “Low Astigmatism – $1,995.00 per eye,” “Toric Lens Implant for Medium to High Astigmatism Correction – $3,025.00 per eye” and “Forever young” surgery’ with “Premium Multifocal Lens (Distance and Near) – $4,125.00 per eye.” You have the option to pay in full, choose a CareCredit interest-free plan, or an extended plan.
At LASight, “If you do not have health insurance coverage of any kind, we offer reasonable rates for care. For standard IOL care (conventional implant) cataract surgery costs are in the range of $4,600 per eye. This includes our preliminary testing, facility fee, surgeon fee and anesthesia fees. Cataract surgery costs for Lifestyle IOLs and Refractive Services, and Laser-Assisted Cataract Care, if desired, are additional.” Beyond that, “It is difficult to quote exact fees for premium IOL treatment because cataract surgery costs can vary depending upon your particular desires or needs, and due to product differences. We therefore prefer not to quote fees over the phone or on the Internet. We understand that this can be somewhat frustrating to someone trying to shop by price alone online, and frankly we don’t condone that approach. There are so many differences between surgeons, surgical technique, lens implants and follow-up care. You need to visit with each surgeon before you make your selection, and base your decision on personal experience obtained at each center.” What does this mean? As always: Do your research. We can’t tell you what your service will charge. If they won’t tell you, that’s a sign.
A YouTube star, @MrBeast, did a promotion making cataract surgery available at no cost for 1,000 people via a doctor who was working with him. (He came under criticism for “charity porn.”)
What you can do
Looking to find a price for your cataract surgery? Here are some questions to ask:
Do you need to pay for a pre-op visit? Some clinics will waive the pre-op cost if you do surgery with them, or they have an all-in cost including pre-op and aftercare, including all medications. Ask about their policy — what’s included?
Will this be outpatient surgery? It almost always is. Out-patient will cost less. Whether out-patient or in-patient, some hospital settings will charge a “facility fee,” which can be pricey.
What are the surgeon’s fees? Is the surgeon in network, and is it all covered?
Knife or laser? As always, we do not give medical advice. Some patients have reported that they are given a choice between a “knife” or a “laser” for the surgery. The implication, of course, is that the laser will be more precise. (The laser usually costs more.) We have eyes; the laser sounds like the preferred choice — the mental picture of someone going toward your eyes with a knife or a laser is graphic. But! While we are not doctors, one of our sources said that some surgeons will say the laser is safer, but there is not clear evidence about this that we could find. This is a good series of questions to ask: Does it cost more? Is it safer? Tell me more, and can you give me a scientific study about this? (This also often holds true, we hear, for Lasik surgery — “Do you want the knife or the laser?”)
Is the anesthesiologist in network?
Is the location where the surgery will be performed in network?
What kind of lens? As always, we do not give medical advice.This is often the biggest variable. Ask your doctor: “Are my eyes healthy enough for this lens?” For further research, try the American Academy of Ophthalmology website’s page on intraocular lenses to do your own research. Perhaps you want to see without glasses after cataract surgery, and perhaps it doesn’t matter to you.
How much is covered by your insurance?
What kind of aftercare is included? A follow-up visit, medication and testing? We have heard reports that antibiotic drops can cost $125 even with insurance. It’s worth asking.
Finally, the Himalayan Cataract Project, at cureblindness.org, is working to do cataract surgery in the developing world. The site says a $25 donation will cover the cost of 10-minute cataract surgery in Nepal or another low-income country.
