Patients can minimize their cataract surgery costs by selecting cost effective lenses and providers. There is a lot of biased information out there on cataract surgery costs because cataract lenses are a “big business” for manufacturers, surgeons, and surgery facilities. The Medicare program and Medicare patients are the most common payors of cataract surgery costs.

Cataract surgery lens costs

If your cataract surgery lens cost is less than $150 per eye, then you cannot be personally billed more for the lenses by the surgeon or surgery center under Medicare rules. If the cataract surgery lens cost is more than $150, then Medicare allows the facility to bill you as the patient for an amount over the $150.

Fortunately, the three most popular cataract lenses all cost less than $150. These are good lenses and will take care of the problem of cloudy vision. You cannot be billed for the cost of these cataract lenses because they cost less than $150. The “xx” in the models below indicates a placeholder for size. Collectively, I estimate these three lenses are used in over 90% of cataract surgeries.

Most Popular Cataract Lenses:

Model: Acrysof IQ SN60WF “xx”
Company: Alcon
Cost: $150
Under Medicare Limit: Yes

Model: Sofport LI61AO “xx”
Company: Bausch & Lomb
Cost: $150
Under Medicare Limit: Yes

Model: Tecnis ZA9003 “xx”
Company: AMO
Cost: $135
Under Medicare Limit: Yes

Based on my estimates, Alcon’s Acrysof IQ above is used in about 50% of cataract surgeries and the Bausch & Lomb’s Sofport and AMO’s Tecnis make up another 40% of cataract surgeries. These marketshare percentages are based on my experience working in the ambulatory surgery business and I have not verified them against actual sales data.

Surgeons may try to “upsell” you into more expensive lenses that will also correct presbyopia or astigmatism, but you will have to pay hundreds of dollars for each lens out of your own pocket. Alcon’s Toric lenses and ReSTOR lenses below are examples of cataract lenses that have large patient out-of-pocket costs.

Cost per Eye of “Premium” Cataract Lenses

Model: Acrysof IQ Toric SN6AT3-5 “xx”
Company: Alcon
Provider Cost: $495
Patient Cost: $345
Under Limit: No

Model: Acrysof IQ ReSTOR
Company: Alcon
Provider Cost: $495-$895
Patient Cost: $345-$745
Under Limit: No

It is significantly less expensive to buy eyeglasses for $120 than to pay an extra $690-$1,490 for premium cataract lenses that will correct presbyopia.

Hospital and surgery center costs

Cataract surgery costs to Medicare patients are significantly lower in ambulatory surgery centers than they are in hospital surgery departments. The surgery costs below are based on 2011 national Medicare rates that may be adjust slightly for your state.

Facility Cataract Surgery Fees for One Eye

Ambulatory Surgery Center
Medicare Pays: $761
Patient Pays: $190

Hospital
Medicare Pays: $1,307
Patient Pays: $326

Patients will save 42% off their cataract surgery costs on coinsurance by going to an ambulatory surgery center instead of a hospital surgery department. The Medicare program itself saves big bucks when patients have cataract surgeries performed in true ambulatory surgery centers instead of hospitals.

Total cataract surgery cost savings

So if a patient goes to an ambulatory surgery center and chooses one of the three lenses under the Medicare allowable limit described in this article, then he or she could save over $1,000 on their cataract surgery costs for both eyes.

Author Bio: Contributed by Nicholas Newsad, M.H.S.A., author of Medical Bill Help and The Medical Bill Survival Guide.

Category: Medical Business
Keywords: medical bill,cataract surgery,hospital