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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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VikingGnome
 
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Medicare CPAP not as bad as GLASSES after cataract surgery

Postby VikingGnome on Wed Aug 28, 2013 4:57 pm

I recently had cataract surgery on both eyes. But I couldn't afford the Toric implantable lens to correct astigmatism ($1,000 per eye). So even after surgery I need glasses. The only time MEDICARE covers eyeglasses or contact lenses is following cataract removal. To have Medicare cover it and pay their 80%, you have to get your new glasses through a contractual provider.

There were only four in my metro area and two of them were Walmarts. I talked to Walmart and they said I had to pay 100% upfront, they would bill for me, and then I might get reimbursed by Medicare up to a year later. That didn't sound at all like a contractual provider.

So I talked to one of the two left and they told me they billed Medicare for me and I only had to pay my co-pay (20%) plus anything extra that Medicare doesn't cover.

Medicare covers basic frames up to $75. Any frame costing more than that, you must pay the extra at 100%. Medicare covers bifocals but NOT "no lines" or progressives. I have worn progressives for the past 12 years so there's no way I was going to try to adapt to a bifocal line. Besides, bifocals would be a problem for me. They would give me close up focus for reading and distance focus for driving. But would not correct my vision enough to have my computer screen in focus. I needed trifocals or progressives.

There was a very limited number of frames under $75 (they tried to sell me titanium frames that cost $250) but I finally found a pair that had nose pieces and no metal touching my face just under $75. My doctor ordered UV protection which Medicare covers at 80%. So overall, I paid 20% for frames, 20% for UV protection, and 20% of the cost of bifocal lenses plus 100% of the difference between the cost of Progressives and bifocals.

Very, very confusing. How do elderly on Medicare understand this stuff? So overall, my new glasses cost me $132 out of pocket. My new ones I bought out-of-pocket last year cost me $289.

Cataract surgery costs: My co-pay under Medicare was $298 per eye, $25 for anesthesia per surgery, $85 for initial eye exam, and $25 for final refraction.

My eye surgeon said that after cataract surgery, I need to have my eyes checked annually from now on (Medicare doesn't cover eye check-ups). And as presbyopia progresses, I'll probably need new glasses every 1-2 years which MEDICARE will never cover.

I seriously wonder why Medicare doesn't cover dental work, hearing aids, and glasses. All of these are necessary to keep an elderly person as socially involved in their world as possible. If they buy cheap, poor-fitting dentures, then they won't wear them and refuse to eat in public (or need a baby food diet). Without a hearing aid, they can't participate in face-to-face conversation or talk to family/friends on the phone. And without glasses with proper correction, they can't see where they are driving those expensive scooters that Medicare buys for them. Lack of social contact is the number one cause of mental decline in the elderly. But our country doesn't WANT people to live long lives. The sooner they die, the less it costs the next generation.

Medicare (and health insurance) is NOT preventive medicine. Yes, they have added a few essentials like mammograms, pap smears, prostate test, bone density testing. But that's it. They don't cover an annual exam, routine blood tests, etc. You have to have a chronic ongoing medical problem that the doctor can bill for to have Medicare cover it. Medicare essentially covers illness and disease.

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LSAT
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby LSAT on Wed Aug 28, 2013 7:50 pm

There is not enough money in Medicare to support the current coverage much less dental, hearing and eye care. Most regular health insurance policies do not cover them either.


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knightlite
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby knightlite on Wed Aug 28, 2013 8:01 pm

You may be lucky, my restor lens last month -- the best cost 2600 per eye after the medicare paid for surgery. 1000 per eye would be good . I have diabetes and medicare pays for most check ups but not the refraction prescription part. If you have a medical reason-- medicare can cover some of the exam. I also spent 5000 this year to care for my teeth, but the one implant failed , they are going to do the replacement for free.
If you don't save and take care of your teeth your whole health will suffer. I would rather spend this on me than a new gas guzzler.
You are correct the government doesn't want you to live a long time. They may pay $ 300,000 on a hospital bill but very little to prevent it. Prevention is all in your court and you can avoid a lot of suffering if you do it. As an ex-smoker I realize tobacco should be very controlled drug, I love a glass of wine but I had to give it all up, I only drink water now . The diet cola snuck up on me , I now know its going to the the next big health problem, I haven't touched it for ten years now. Sugar is in everything now ,I wish they would put a high tax on it, now start with $5.00 on five pounds.
That's the only way to slow the use of it. Just my opinion, like to save my grandchildren from some of this stuff, too late for me.

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now using mirage quattro ffm with pad a cheek liner , hose hanger on head board with 18 inch short hose /swivel to 6 foot hose-- DS560 apap set 10-14.5

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Bons
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby Bons on Wed Aug 28, 2013 8:24 pm

Many health insurance plans have dental and optical care as an option rather than part of the standard coverage. Our optional optical insurance pays only for standard bifocals, which is why I have no optical coverage.

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Julie
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby Julie on Wed Aug 28, 2013 9:19 pm

Had a recent cataract removal (one only) and didn't get torics either because of expense (only $400 here), but planned to get glasses afterward for astigmatism. I didn't (so far anyhow) because after other related expenses they'll come out to a lot more than the $150. originally quoted, but will see as time goes by how much I need them or not. But the surgery was free (up here in the great white north)!

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VikingGnome
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby VikingGnome on Wed Aug 28, 2013 9:31 pm

knightlite wrote:You may be lucky, my restor lens last month -- the best cost 2600 per eye after the medicare paid for surgery. 1000 per eye would be good .


What kind of IOL is "restor?" Is it the new presbyopia lens that automatically adjusts as your myopia gets worse over the years? That would be quite a bit more expensive than a TORIC IOL.

_________________
Machine: S9 VPAP S BiLevel Machine
Mask: Hans Rudolph 7600 Series V2 Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Pressure Setting 22/18; Pregnancy pillow to keep me sleeping on side; Pad-A-Cheek mask liner

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idamtnboy
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby idamtnboy on Wed Aug 28, 2013 10:18 pm

VikingGnome wrote:My eye surgeon said that after cataract surgery, I need to have my eyes checked annually from now on (Medicare doesn't cover eye check-ups). And as presbyopia progresses, I'll probably need new glasses every 1-2 years which MEDICARE will never cover.

If my experience is any indicator you are overstating the negatives. I had cataract surgery something like 10 to 12 years ago. My astigmatism and eyeball shape has changed very, very, little. You will have no more presbyopia condition, if that is what you actually meant to say. That is the hardening of the lens that restricts focusing ability. Plastic lens don't flex like natural lens do. Your natural lens was removed, that is the interior gel was removed. The plastic lens resides inside the sac of the natural lens. Your focusing ability is now fixed for life, i.e., you don't have any. If you meant near sightedness, or myopia, that will change hardly at all from now. Your eyeball shape was pretty well fixed by the time you hit your 50's.

I was exceedingly near sighted before the surgery. The IOL corrected both eyes to about 20/40. Because of astigmatism I was going to have to wear glasses anyway so correction to that point combined with the astigmatism correction led to a somewhat uniform glasses lens shape. I have 5 prescriptions, one trifocal and one bifocal. The tri has lens ground for quite close up, roughly 6 to 12 inches focal distance, second for about the distance for car dash, and third for distant vision. I still have a region from about 6 to 10 feet where focus is just a touch fuzzy. The bifocal is set for computer screen distance and for newspaper reading close up, i.e., bottom of page close to me.

I have a pretty good vision insurance plan so pay a modest out of pocket. It allows for one exam and one new pair of glasses every year. I alternate getting the computer glasses and the trifocals. There is often no change in the prescription, which means I can go 4 to 6 years with very little vision change, less than the 1/8 or 1/4 diopter difference in lens grind. What I have found is the glasses lens get scratched up and the frames deteriorate in about 2 years so the 2 year cycle works good to keep me in glasses that are in good, but not necessarily perfect, condition.

So, in essence, I buy glasses because they deteriorate, not because my eyesight changes. BTW, my vision insurance restrictions are much the same as what you encountered with Medicare, so Medicare is not that unusual. As stated above, Medicare will pay for eye exams if there is a medical basis for them.

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zoocrewphoto
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby zoocrewphoto on Wed Aug 28, 2013 11:28 pm

LSAT wrote:There is not enough money in Medicare to support the current coverage much less dental, hearing and eye care. Most regular health insurance policies do not cover them either.


Mine does, though that may be about to change. Our contract expired 3 months ago, and while we were told before the elections that we were exempt and/or okay until at least 2018; our contract negotations are now discussing reduction of benefits, hours below 30, and a reduction of sunday and holiday pay. I suspect our contract won't be done until October.

I am glad I got my dental work done in December and January. I wasn't sure if we would continue to have dental or not.

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archangle
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby archangle on Sat Aug 31, 2013 4:25 pm

First, be sure to write to your congressmen every time you get screwed by Medicare. They don't really care about your opinion, but something may happen if they get enough complaints. For sure, nothing will get fixed if we don't complain. There are big money interests paying big bribes to congress to keep Medicare screwed up.

Second, look at Zenni Optical online. Very good prices. I've bought single vision glasses with astigmatism correction for $10, no line bifocals for under $50. You don't have to send in a copy of your prescription, so you can tweak your prescription (for instance for reading glasses) if you know how.

I've gotten a dozen or so pairs of glasses from them over time with no problems.

You don't don't get the easy repair service you get from a local provider, but for the prices, you can just buy an extra pair or two. I keep a spare pair in my car in case I have problems while away from home. I also ordered some single vision glasses for special purposes. One set just right for my computer monitor, one for really close work, and a pair for distance vision only for astronomy. At $10 each, you can afford to experiment a bit.

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midnight_skulker
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby midnight_skulker on Sat Aug 31, 2013 8:05 pm

This is good news to me. I've worn eyeglasses forever. I'm on Medicare. I didn't know that Medicare covered any eyeglassses. So far I don't need cateract surgery. I order my eyeglasses on the internet at a much lower cost than any retail store.

knightlite
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby knightlite on Sun Sep 01, 2013 10:04 am

VikingGnome wrote:
knightlite wrote:You may be lucky, my restor lens last month -- the best cost 2600 per eye after the medicare paid for surgery. 1000 per eye would be good .


What kind of IOL is "restor?" Is it the new presbyopia lens that automatically adjusts as your myopia gets worse over the years? That would be quite a bit more expensive than a TORIC IOL.


Yes! it is the newest adjustable lens , your eye muscles work it like your original lens . I could afford the out of pocket so I went with it. So far so good . Hopefully no glasses ever for me again . Still taking the eye drops at this time.

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Humidifier: PR System One Heated Humidifier
Additional Comments: apap ds560 sleepyhead software/with patch, resmed hose cozy, pressure set 10 toa 14.5 , aflex of 3 ,ramp off, not using heated hose
now using mirage quattro ffm with pad a cheek liner , hose hanger on head board with 18 inch short hose /swivel to 6 foot hose-- DS560 apap set 10-14.5

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JeffL
 
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Re: Medicare CPAP not as bad as GLASSES after cataract surgery

Postby JeffL on Sun Sep 01, 2013 4:40 pm

knightlite wrote:
VikingGnome wrote:
knightlite wrote:You may be lucky, my restor lens last month -- the best cost 2600 per eye after the medicare paid for surgery. 1000 per eye would be good .


What kind of IOL is "restor?" Is it the new presbyopia lens that automatically adjusts as your myopia gets worse over the years? That would be quite a bit more expensive than a TORIC IOL.


Yes! it is the newest adjustable lens , your eye muscles work it like your original lens . I could afford the out of pocket so I went with it. So far so good . Hopefully no glasses ever for me again . Still taking the eye drops at this time.


Does it correct astigmatism too? When I got my surgery 15 months ago, the IOLs that were both adjustable and corrected astigmatism were not FDA approved. I went with the TORIC for astigmatism, but I'm totally frustrated with the inability to clearly focus within 7 feet, and the need to switch between 2 different strengths of "reading" glasses and no glasses to compensate. I may have to try progressive lenses.

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