Does Anthem Blue Cross and Blue Shield Cover Cataract Surgery?

Anthem Blue Cross and Blue Shield Medicare Advantage plans provide coverage for everything covered under Medicare Part A and Part B, which may include cataract surgery.

Specifically, an Anthem Blue Cross and Blue Shield (Anthem) Medicare Advantage plan may cover the removal of the cataract, a basic lens implant and a set of eyeglasses or contact lenses following the surgery. 

When Does Anthem Blue Cross and Blue Shield Cover Cataract Surgery?

An Anthem Medicare Advantage plan may cover cataract surgery when the procedure is considered medically necessary by Medicare and performed by a doctor who accepts Medicare.

Depending on the type of Anthem Medicare Advantage plan you have, you may need to have the surgery performed by an in-network doctor for the procedure to be covered by your plan. HMOs or Health Maintenance Organization plans generally require you to visit an in-network doctor to receive coverage. PPOs, or Preferred Provider Organizations, often allow you to seek medical care from non-participating providers and still receive some coverage.

What is Considered “Medically Necessary” for Cataract Surgery?

Cataract surgery may be considered medically necessary if:

1. A cataract is causing visual impairment that cannot be corrected with glasses or contact lenses
2. A cataract is preventing other eye problems from being treated
3. You have a lens problem that could harm your eyesight or health

Medicare may consider additional circumstances not listed above as medically necessary and eligible for coverage.

How Much Does Medicare Pay for Cataract Surgery in 2024?

The amount that Medicare will pay for cataract surgery in 2024 depends largely on the type of Medicare coverage you have.

Medicare Part B will typically cover 80% of the cost of cataract surgery in 2024 after the annual Part B deductible has been met.

Anthem cataract surgery coverage may differ from that of Medicare Part B. Some plans may feature copayments or coinsurance amounts that differ from Original Medicare. Some plans may even have $0 deductibles.

Factors that may affect the cost or coverage of cataract surgery include:

• Potential complications
• Additional medical conditions
• How long the surgery takes
• Type of surgery needed

What is the Copay for Cataract Surgery?

Medicare Part B requires a 20% coinsurance payment for most covered services after the annual Part B deductible is met.

Medicare Advantage plans may require coinsurance or copayment amounts that are more or less than the 20% required by Medicare Part B. However, cost-sharing amounts can vary from one plan to another, so speak to a licensed insurance agent about the coinsurance or copayment requirements in the Anthem plans available near you.

Does Anthem Cover Laser Cataract Surgery?

Medicare’s coverage for cataract surgery is the same whether the procedure is performed with conventional techniques or a laser.³ Therefore, Anthem Medicare Advantage plans cover cataract surgeries that use traditional surgical techniques and lasers, as long as they are medically necessary. 

Does Anthem Provide Any Additional Vision Coverage?

While Original Medicare does not provide routine vision care, Anthem Medicare Advantage plans often do. Benefits typically include coverage of routine eye exams along with eyeglasses or contact lenses.

Many Anthem plans also provide prescription drug coverage and may offer coverage of medications used for cataract surgery or other vision treatment.

How Do I Enroll in an Anthem Medicare Advantage Plan?

Contact a licensed insurance agent to learn about the Anthem plan options available where you live. An agent can also help you review the vision coverage included in each plan, check your eligibility and help you enroll at the appropriate time.

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