Toni,
Will be eligible for Medicare in 2016 and trying to compare Medicare to my current company benefits? I am concerned that if I need cataracts removed that this procedure will not be covered with Medicare.
I can take my company dental and vision benefits when I retire and am wondering if that is a good idea or are dental/vision benefits available with Medicare.
~ Tim from Dallas
Does Medicare Cover Cataract Surgery?
Hello…Tim:
Regarding your question, “Does Medicare Cover Cataract Surgery,” Medicare covers many medically necessary surgical procedures and cataract surgery is covered. See page 49 under eyeglasses to learn about cataract coverage.
If you’re having surgery or a procedure, you can do some things in advance to figure out approximately how much you’ll have to pay.
- Ask the doctor, hospital, or facility how much you’ll have to pay for the surgery and any care afterward.
- Make sure you know if you’re an inpatient or outpatientbecause what you pay may be different.
- Check with other insurance you may have (like a Medicare Supplement Insurance (Medigap) policy, Medicaid, or coverage from your or your spouse’s employer) to see what it will pay. If you belong to a Medicare Advantage plan, contact your plan for more information and how they will pay.
On page 71 of the 2016 Medicare & You handbook under “What’s NOT Covered by Part A & Part B?” It states… “Medicare does not cover everything and if you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless you have other insurance to cover the costs.”
The Medicare & You handbook also states…
- You may have other insurance (including Medicaid) that could cover the costs.
- You may be in a Medicare health plan such as Medicare Advantage (Part C) that may cover these services.
- Remember, that if Medicare covers a service, then you generally have to pay deductibles, coinsurances and co pays.
What Medicare Does Not Cover
Long-term care, routine dental care, dentures, cosmetic surgery, acupuncture, hearing aids and exams for fitting hearing aids are not covered.
Since Medicare doesn’t cover dental, I would recommend that you talk to your dentist and see which dental insurance plan he/she prefers.
On page 50 of the 2016 Medicare handbook, it talks about eyeglasses, which is a limited benefit because Medicare will cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. The Medicare Part B deductible will apply and you will pay the 20% of the Medicare-approved amount.
Hearing aids are also considered elective, just like glasses. “Medicare covers the exams if your doctor or other health care provider orders them. Again you pay the 20% of the Medicare-approved amount and the Part B deductible applies.” Medicare does not cover the hearing aids or exams for fitting the hearing aids and this can be expensive.
And if you can keep these ancillary benefits when you retire, it may be a good idea. Group benefit plans are generally more comprehensive.
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