Does WellCare Cover Cataract Surgery?

In this article...
  • Find out if and when WellCare covers cataract surgery. Explore some of the benefits you could receive, and discover the potential out-of-pocket costs.

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Medicare Advantage plans from WellCare may cover medically necessary cataract surgery. As a Medicare Advantage provider, WellCare is required to include all the benefits of Original Medicare (Part A and Part B). Since cataract surgery is covered by Medicare Part B, it's automatically included in WellCare Medicare Advantage plans.

Keep in mind that WellCare Medicare Advantage plans are not available in all states and counties. Specific coverage may vary based on your health and choice of provider.

When Does WellCare Cover Cataract Surgery?

As a Medicare Advantage provider, WellCare must follow the government's criteria for cataract surgery. Typically, Medicare covers cataract surgery if a doctor determines that it's medically necessary. In addition, the surgeon must use lasers or traditional techniques during the procedure.

Any time you use a Medicare Advantage plan, you must visit a provider that accepts Medicare. WellCare may impose additional restrictions. Some of the company's plans require you to use an in-network doctor, while others also cover out-of-network providers. 

What Kind of Cataract Surgery Coverage Does WellCare Offer?

If your WellCare vision plan follows Medicare's standard coverage limits, it may include:

  • 80% of the Medicare-approved amount for cataract removal and lens implantation
  • One pair of standard-frame glasses or contact lenses from a Medicare-enrolled supplier

Some WellCare plans may offer additional coverage; check your benefits statement or quote for specifics. 

Cataract surgery usually involves out-of-pocket costs, even if you're insured by WellCare. Your deductible, copay and coinsurance can impact the final bill.

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How Do I Use a WellCare Vision Plan for Cataract Surgery?

Medicare only covers cataract surgeries when they're medically necessary. Typically, that means that you'll need to get the go-ahead from your regular doctor. After that, you can get a referral to a surgeon that accepts Medicare; check your plan to see if the surgeon must be part of the WellCare vision network. 

The surgeon's office will schedule appointments and file insurance claims on your behalf. You may be responsible for a copay or additional fees.

If you need contacts or glasses after surgery, be sure to order them through a Medicare-affiliated supplier. Glasses can be expensive, so it's a good idea to verify the coverage limits in your WellCare plan.

Does WellCare Vision Provide Additional Coverage?

If you continue to have vision problems after cataract surgery, your WellCare vision policy may offer additional vision benefits. Coverage varies by state and the type of plan, but some potential benefits are:

  • Eye exams
  • Eyeglass or contact lens allowance
  • Eye screenings
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