I've got a Medicare Advantage plan, and I'm curious if my upcoming eye surgery is fully covered or if I'll owe extra out of pocket.
Answered by 12 licensed agents
That would be a great question to ask the provider prior to the surgery. A good ophthalmologist office Is usually very aware of the codes that they will bill to Your Medicare advantage plan And they may Tell you your cost. You should also be able to contact your Medicare advantage plans member services number and they can answer that question for you. If it is a cataract surgery, that’s a little different. Medicare fully covers cataract surgery with a standard lens. If you are using any type of upgraded lens, then Medicare will not pay for the upgraded lens And you will be financially responsible for that cost.
Your Medicare Advantage will cover cataract surgery, most Medicare Advantage plans will have an outpatient co pay for the facility, and a co pay for your surgeon. You will need to talk to your agent OR the carrier to find out yur co pays, what your plan will pay & additional benefits
This depends on the nature of the procedure. Medically necessary cataract surgeries are for the most part covered by all Medicare Advantage plans and you will typically pay your plan's outpatient surgery amount or copay. If you need cataract surgery on both eyes, expect to pay an additional copay for the second eye. There is a very nice, "enhanced," multifocal procedure which is not an approved benefit by Medicare and this is likely not covered by any Advantage plan. Expect to pay $ 5,000 per eye for the privilege of not needing reading glasses! If your upcoming eye surgery is other-than-cataract, ask you doctor to secure a Prior Authorization from your plan before going ahead with the work.
If it’s an out patient surgery, you have your out patient surgery co pay. If it is as an in patient, then you would have that co pay. Check your materials for your evedence of coverage.
Bear in mind that there are over 60,000 treatments that are covered by a government subsidized Medicare Advantage plan, being your Primary insurance at 80%. The rest of the money or 20% is paid by Medicare itself, your Secondary insurance. However, some things written in the policy may not be completely covered. Your doctor should know that! This is the “give and take” since you’re responsible for a somewhat steep deductible since you likely have no monthly premium.
No Medicare Advantage plan covers surgery fully or 100 percent. You will have a copay for the surgery whether it’s inpatient or outpatient. I would call member services on the back of your insurance card to get an idea of what it will cost.
This question omits information like whether the surgery is being performed by an in network or out of network physician but in either case, there will be an out of pocket amount to the patient in the form of deductibles; co insurance; and Co Pays.
Well what is the surgery? That is the only way we can properly assess coverage. If the surgery is medically necessary (like cataract or glaucoma surgery), it’s likely to be covered, but there could still be out-of-pocket costs like co-pays, deductibles, or coinsurance. If the surgery is elective (like LASIK), it probably won’t be covered by your Medicare Advantage plan. Make sure to check with both your Medicare Advantage provider and the surgical center to understand exactly what will be covered and any potential out-of-pocket expenses.
Until your plan is reviewed by a licensed Medicare agent, we can not provide an accurate overview of what your plan will pay for. A licensed Medicare agent can review your plan and provide an update on whether your eye surgery is fully covered or not.
