Does Kaiser Senior Advantage Cover Cataract Surgery?
- Kaiser Senior Advantage plans do cover cataract surgery. All Medicare Advantage (Medicare Part C) plans cover cataract surgery, and some Kaiser Medicare plans may cover extra vision benefits such as prescription glasses, eye exams and more.
Cataracts are a symptom of aging, and more than half of adults over the age of 80 are either living with cataracts or have had surgery to correct them.
Fortunately, Medicare Part B provides coverage for cataract surgery. This means that all Medicare Advantage (Medicare Part C) plans – including those offered by Kaiser Permanente – are required to cover medically necessary cataract surgery.
All Medicare Advantage plans – including Kaiser Senior Advantage Medicare plans – are required to cover all of the same services and items that are covered by Original Medicare (Medicare Part A and Part B). And because Original Medicare covers cataract surgery, so too do all Medicare Advantage plans including Kaiser Senior Advantage plans.
How Much Does Cataract Surgery Cost With Kaiser Senior Advantage?
The Kaiser Senior Advantage plan requires no annual deductible for covered cataract surgery costs. Plan members may typically owe a copayment or coinsurance for the cataract surgery, which generally includes the removal of the cataract and insertion of an artificial lens. Exams to diagnose cataracts are also covered by the plan.
Kaiser Senior Advantage then covers eyeglasses or contact lenses following the procedure. There may be a coinsurance requirement for the eyeglasses.
If any prescription drugs are needed following the procedure, a Kaiser Senior Advantage plan that provides prescription drug coverage and may cover the needed medication.
When Does Medicare Pay for Cataract Surgery?
Medicare Advantage plans like the Kaiser Senior Advantage plan may impose some of their own conditions for cataract surgery. These conditions may include certain requirements to determine coverage eligibility, network restrictions and more.
But looking at the Original Medicare requirements for cataract surgery coverage can serve as a baseline for what you might be able to expect from a Medicare Advantage plan like Kaiser Senior Advantage.
Under Original Medicare, coverage includes any exams related to the procedure, the removal of the cataract, the insertion of a basic lens implant and one set of eyeglasses or contact lenses following the procedure.
Original Medicare beneficiaries are responsible for a 20% coinsurance payment for cataract surgery once the Medicare Part B annual deductible has been satisfied. Another 20% coinsurance payment applies for the post-operative eyeglasses or contact lenses.
Medicare requires the surgery to be medically necessary and performed at a Medicare-approved facility by a doctor who accepts Medicare assignment or participates in Medicare. The supplier of the eyeglasses or contact lenses must also be enrolled in Medicare.
Medicare only covers a basic set of artificial lenses. If a more advanced type of lens is implanted, it may not be eligible for coverage.
These are some of the basic terms and conditions surrounding Original Medicare coverage of cataract surgery, which can give you a general idea of how the procedure may be covered by a Medicare Advantage plan like Kaiser Senior Advantage.
What Other Vision Benefits are Included with Kaiser Senior Advantage?
Like many Medicare Advantage plans, Kaiser Senior Advantage provides some vision coverage. These benefits can include:
- Annual routine eye exams
- Visits to diagnose and treat eye diseases and conditions
- Screenings for glaucoma and diabetic retinopathy
- An allowance every 2 years to purchase eyewear (available only with the optional upgrade to Advantage Plus)
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