Pro Tip: Hospice involves both attentive medical care and palliative care assistance to terminally ill patients. Read my article Does Medicare Cover Hospice?
Does Medicare Cover Cataract Surgery?
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September 22, 2023
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When performed using traditional surgical techniques or lasers, cataract surgery is covered by Medicare. That said, cataract surgery comes with additional expenses, some of which are not covered.
To learn how Medicare covers cataract surgery, watch our short video.
The average out-of-pocket cost of cataract surgery in the United States ranges from $3,500 to $7,000 per eye. Medicare can be a lifesaver for many Americans because it potentially covers at least 80 percent of the cost — although there are limitations.
Medicare typically covers cataract surgery if a physician deems it medically necessary. Since Original Medicare consists of both Medicare Parts A and B, a majority of the coverage will come from Part B as long as the deductible is met.
Under Part B or outpatient insurance, Medicare will pay 80 percent of the cost of cataract surgery as well as the cost of eyeglasses or contact lenses post-surgery. You will owe 20 percent of the Medicare-approved amount.
If you have a Medicare Advantage plan, your private carrier will pay for your medical costs instead of Medicare. Private insurers must offer benefits as good as Medicare, but the benefits are not standardized. Each plan has its own summary of benefits, so you’ll need to contact your carrier directly to find out how much it will cover and how much you’ll have to spend out of pocket.
If you have a Medigap plan, the 20 percent coinsurance under Part B will be covered. Medigap will always pay the leftover coinsurance under Part B as long as Medicare pays its portion.
There are several nonsurgical cataract treatment options to consider. Some people may delay cataract surgery since cataracts often worsen slowly. Nonsurgical options include wearing sunglasses that block harmful UV rays, investing in new prescription glasses or contacts, making lifestyle changes, and seeking vision correction from an ophthalmologist. All these options are based on your unique situation, so it’s best to consult a doctor to see whether they advise nonsurgical cataract surgery.
Medicare generally doesn’t cover nonsurgical cataract treatments. There is an exception, however, for patients who have undergone cataract surgery and then require nonsurgical cataract treatments. Medicare Part B, for instance, helps pay for corrective lenses on the condition that you are undergoing cataract surgery to implant an intraocular lens. You would receive one pair of eyeglasses with standard frames or a pair of contact lenses. If you have a Medicare Advantage plan, then check whether your plan offers additional benefits for vision.
If you find that nonsurgical cataract treatment does not help your vision, it may be time to consult a doctor about surgical cataract treatment.
Pro Tip: Hospice involves both attentive medical care and palliative care assistance to terminally ill patients. Read my article Does Medicare Cover Hospice?
Cataract surgery can be expensive, but there are ways to offset the cost with certain Medicare plans. Out-of-pocket cataract surgery generally costs upwards of $3,700.
As a hypothetical example, Brenda is a 67-year-old woman with diabetes who needs cataract surgery for only one eye, which starts at $3,783. Medicare covers approximately 80 percent of the cost, but she would be required to pay the 20 percent coinsurance in addition to the Part B deductible, which is $203 for 2021.
Here’s what Brenda’s costs may look like:
| Cost of cataract surgery | Medicare coverage | Out-of-pocket cost | Deductible | Total cost |
|---|---|---|---|---|
| $3,783 | $3,026.40 | $756.60 | $203 | $959.60 |
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Medicare generally doesn’t pay for vision care or cover routine eye exams for eyeglasses or contact lenses, which means you are responsible for 100 percent of the cost. There is one exception though: Medicare Part A may cover vision care for patients admitted to the hospital when their vision is deemed a medical problem.
Medicare Part B covers cataract removal since it’s deemed medically necessary. This coverage also includes artificial lenses and products to correct vision, such as prescription glasses with frames. Individuals typically pay 20 percent of the Medicare-approved amount for vision care items such as glasses or contact lenses after their cataract surgery. Medicare Part B covers some vision care, but it doesn’t cover vision exams or eye refractions.
Medicare Part B also covers a set of contact lenses and prescription eyeglasses needed after cataract surgery. Medicare covers intraocular lens implants for cataract surgery, but advanced implants are generally not covered. Medicare Part D, or prescription coverage, may cover certain vision-care products, such as prescription eye drops or other vision-related prescriptions.
Learn More: Are you looking to have your annual eye exam to check for eye diseases such as macular degeneration and glaucoma? Read my article on the best dental and vision insurance for seniors.
Medigap works by filling the gaps of Original Medicare and covering additional costs. Medigap generally doesn’t cover long-term care, vision, or dental, as well as hearing aids and eyeglasses. Medigap can cover some remaining costs of cataract surgery, however, such as Part A and Part B deductibles and coinsurance.
FYI: To learn more about Medigap, read my rundown of the best Medigap policies.
Medicare Advantage covers cataract surgery. Your private health insurance provider may cover the full cost of cataract surgery on the condition that you pay outpatient surgery copayments or a deductible. Contact your Medicare Advantage plan provider to see which costs are covered and what you’ll have to pay out of pocket depending on your plan.
To learn more about this type of coverage, read my guide Medicare Advantage vs. Medigap.
Medicare generally doesn’t provide routine eye exams or vision care, but it will cover medically necessary cataract surgery or vision care post-surgery. There are other plans, such as Medicare Advantage and Medigap, that may assist with the remaining costs of cataract surgery and other costs under certain conditions. It can be stressful to seek help to correct vision problems, but it’s important to speak with a physician about both nonsurgical and surgical options that best work for your unique health needs.
Medicare generally can cover up to 80 percent of cataract surgery costs, which means you’ll have to pay the remaining 20 percent. The exception is that Medicare will pay for cataract surgery if your physician deems it medically necessary.
Cataract surgery may start at $3,500 per eye. Medicare Part B can pick up 80 percent of that amount under certain criteria, which means about $2,800 would be covered and you would have to pay the deductible and remaining $700 out-of-pocket cost.
Medicare covers manual blade surgery, laser surgery, and intraocular lenses. Certain laser surgeries with advanced lenses, however, may require individuals to pay additional out-of-pocket costs.
For Medicare coverage, your physician needs to determine that the procedure is medically necessary. Due to the slow progression of cataracts, many people may delay cataract surgery or choose nonsurgical methods on the advice of their physician. If cataracts affect your day-to-day activities and result in significant vision loss or blurred vision, then it’s time to reconsider.