Is Vitrectomy Surgery Covered by Medicare?

elderly woman with glasses having difficulty reading her phone stock image

By Daniel Petkevich

Dec 2, 2022

The answer may depend on your choice of plan

Medicare offers coverage for treatments and procedures they deem to be medically necessary. Vitrectomy surgery is no exception. But some Medicare Advantage plans might deny coverage and require you to pay out-of-pocket for the surgery. Which plans will help you spend less? Let's find out.

Stay Up to Date on Medicare!

Header brushstroke decoration.

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

What is Vitrectomy Surgery?

Vitrectomy surgery is a type of eye surgery that removes the vitreous humor, or gel-like substance, from inside the eye. This procedure is often done to treat conditions such as retinal detachment and macular degeneration.

What are the benefits of Vitrectomy surgery?

Vitrectomy surgery can help improve vision by removing scar tissue, repairing retinal tears, or restoring normal blood flow to the eye. It can also reduce pain and discomfort associated with these problems.

Medicare Coverage for Vitrectomy Surgery

Medicare Part B typically covers 80% of the cost of vitrectomy surgery , including doctor visits and lab tests related to the procedure. However, you may be responsible for a portion of the remaining cost. Medicare also requires that your doctor provide documentation stating why the surgery was medically necessary for it to be covered.

What is the cost of vitrectomy surgery?

The cost of vitrectomy surgery depends on the type of procedure you have and your insurance coverage. Generally speaking, it can range anywhere from $1,000 to $7,000 per eye. Be sure to check with your doctor and insurance provider for more specific information about your situation.

How to qualify for Medicare coverage of vitrectomy surgery?

In order to qualify for Medicare coverage of vitrectomy surgery, your doctor must certify that the procedure is medically necessary. Your doctor will need to provide documentation and obtain prior authorization from your insurance provider before the procedure can be scheduled. Additionally, you'll also have to meet any other requirements set by your insurer.

There have been some instances of Medicare Advantage plans denying this procedure, in which case, you might have to pay for the cost of surgery out-of-pocket. That is why we typically recommend Medicare Supplement Plan G to our clients for the most comprehensive coverage.

Does Medicare cover vitrectomy chairs?

After vitrectomy surgery, many people find it more comfortable to rest in a face-down position. Medicare does not cover specialized chairs designed for this type of procedure, as they are not deemed medically necessary.

Alternatives to vitrectomy surgery

In some cases, vitrectomy surgery can be avoided through less invasive treatments such as laser therapy or injection of medications. Talk to your doctor about the potential alternatives that may be available to you before deciding if a vitrectomy is the best course of action for your eye condition.

Takeaway

Vitrectomy surgery is a safe and effective way to treat certain eye conditions. In most cases, Medicare Part B will cover 80% of the costs associated with vitrectomy surgery as long as it is deemed medically necessary by your doctor. However, some Medicare Advantage plans may not cover this procedure, and you may end up having to pay out-of-pocket for the cost of the surgery. Before pursuing this surgery, talk with your doctor to see if it's right for you. This content is for informational purposes only. Fair Square Medicare is here for all your Medicare-related questions.

Stay Up to Date on Medicare!

Header brushstroke decoration.

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Learn More About Medicare


Birthday stock image

What Is the Medicare Birthday Rule in Nevada?

Mar 28, 2023

Ozempic stock image

Does Medicare Cover Ozempic?

Mar 28, 2023

Pre-Existing condition stock image

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Mar 28, 2023

Cover image

What People Don't Realize About Medicare

Mar 27, 2023

woman in a hospital wearing a bandana being shown information by her doctor stock photo

Medicare Advantage Plans for Disabled People Under 65

Mar 24, 2023

senior couple working in a greenhouse stock image

Medicare Supplement Plans for Low-Income Seniors

Mar 23, 2023

Kansas farm stock photo

Medicare Savings Programs in Kansas

Mar 22, 2023

Cover image

How Much Does a Medicare Coach Cost?

Mar 20, 2023

20 Q's with Fair Square

20 Questions to Ask Your Medicare Agent

Mar 17, 2023

Washington DC stock image

14 Best Ways for Seniors to Stay Active in Washington, D.C.

Mar 11, 2023

Nashville city skyline stock image

14 Best Ways for Seniors to Stay Active in Nashville

Mar 10, 2023

Seattle Public Market stock image

14 Best Ways for Seniors to Stay Active in Seattle

Mar 10, 2023

Union Station in Denver stock image

15 Best Ways for Seniors to Stay Active in Denver

Mar 9, 2023

Indianapolis skyline at night stock image

13 Best Ways for Seniors to Stay Active in Indianapolis

Mar 9, 2023

Charlotte skyline stock image

14 Best Ways to Stay Active in Charlotte

Mar 9, 2023

senior couple doing yoga stock image

13 Best Ways for Seniors to Stay Active in Columbus

Mar 8, 2023

Philadelphia skyline at sunset stock image

13 Best Ways for Seniors to Stay Active in Philadelphia

Mar 7, 2023

Arizona desert stock photo

13 Best Ways for Seniors to Stay Active in Phoenix

Mar 6, 2023

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap.

100% free.

Fair Square Medicare

LEGAL

Privacy Policy

MORE


Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M