Does Medicare Cover Cataract Surgery?

Medicare and Cataract Surgery

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.

Nonsurgical Cataract Treatment and Medicare

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.

Cost of Cataract Surgery With Medicare

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:

What Does Medicare Pay for Vision Care?

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.

Medigap and Cataract Surgery

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.

Medicare Advantage and Cataract Surgery

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.