Does Medicare Cover Cataract Surgery?

Getting cataract surgery can make all the difference in preserving your vision into your older years. Medicare can cover cataract surgery in most instances but it is important to understand your coverage before scheduling your procedure. This article will break down the differences in cataract surgery coverage for those who have Medicare health insurance. 

Summary: Does Medicare Cover Cataract Surgery?

Medicare does cover cataract surgery that is deemed medically necessary by a doctor. Depending on your exact coverage, you may still have some out-of-pocket costs. Typically, Medicare will help pay for cataract surgery using conventional intraocular lenses as well as one pair of eyeglasses following each cataract surgery. Several factors will influence how much of the cost will be covered by Medicare including:

• The type of medicare coverage you have 
• Whether you have a supplemental plan like Medigap to cover additional expenses
• Where you live
• The facility where you have the procedure done (surgery center versus hospital) 

What Type of Lens Does Medicare Cover for Cataract Surgery?

Medicare covers cataract surgery that uses standard or conventional intraocular lenses. Sometimes, advanced lenses are needed to correct astigmatism or nearsightedness and Medicare does not typically cover the cost of those. 

Does Medicare Cover Laser Cataract Surgery?

According to Medicare.gov, Medicare will cover cataract surgery done using lasers. Many insurance companies consider laser cataract surgery to be an elective surgery and usually do not cover it. 

If the surgery is being performed to repair lenses affected by cataracts, it should be covered. However, getting laser surgery to simply correct subtle vision issues is not the same. 

The Scope of Medicare Part B and Part C in Cataract Surgery

Medicare plans can be broken up into different parts including parts A, B, C and D. Medicare Part A covers inpatient medical care, such as an overnight hospital visit. Because cataract surgery does not typically require hospitalization, Medicare Part A would not be used to cover the cost of cataract surgery.

Medicare Part B covers outpatient medical costs. Under original Medicare, Part B will cover cataract surgery as well as doctor appointments needed before and after your procedure. 

Medicare Part C is also known as a Medicare Advantage Plan. It covers everything that Medicare Parts A and B cover with additional benefits such as routine vision and dental care. 

Medicare Part D covers prescription drugs. This would include eye drops, which may be needed after cataract surgery. If you have a Medicare Advantage plan that includes Part D, your prescription medications related to the surgery will also be covered.

If you have original Medicare, cataract surgery will be covered under Part B. If you have a Medicare Advantage Plan or Part C, you will still be able to have cataract surgery covered and may save additional money on out-of-pocket costs. 

Medicare Supplement plans or Medigap can also help to cover additional expenses. This is an optional add-on to an original Medicare plan that helps to cover extra expenses such as copayments and any extra out-of-pocket costs. 

Cataract Surgery Costs With and Without Medicare

Original Medicare will likely cover around 80% of the cost of cataract surgery. You will be responsible for your annual deductible which is $240 in 2024 as well as 20% of the cost of the procedure. 

The average total cost of cataract surgery falls anywhere from $3,500 to $7,000 per eye. This amount varies depending on where you live and where you seek treatment. This means that with Medicare coverage, you could pay anywhere from $700 – $1,400 (in addition to your copay) for cataract surgery but these numbers vary depending where you live. 

Potential Restrictions: What Type of Cataract Surgery Does Medicare Not Pay For

Medicare does not cover cataract surgery with astigmatism correction. In order for cataract surgery to be covered by Medicare it must be deemed medically necessary by a medical doctor, meaning it causes vision changes that interfere with day-to-day activities. 

Post-Cataract Surgery: Does Medicare Cover Glasses After the Procedure?

Yes, Medicare will cover the cost of one pair of prescription glasses and lenses following cataract surgery. Many people are surprised to hear about this benefit since Original Medicare plans do not typically cover routine vision care. 

Accessing Quality Eye Care at UCF HealthFaculty Physician Practice

Finding the right provider is essential in getting treatment for cataracts. Cataracts can lead to debilitating vision changes so getting them corrected can make all the difference in enhancing your quality of life. A highly skilled provider will offer the best recommendations in treating cataracts surgically, giving you exactly what you need to recover quickly and feel your best. 

Sources

https://www.medicare.gov/coverage/cataract-surgery

https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare

https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles