Hollay Ghadery Last Updated On: August 4, 2023

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A Guide to Cataract Surgery Coverage and More

Cataract Surgery Coverage

Your eye health matters. But cataracts can affect so many of us as we age. This leads many of us to wonder, does Medicare cover cataract removal surgery? 

The short answer is that yes, in most cases you are covered for cataract surgery if you have Medicare. The longer answer is a bit more nuanced, and covers costs to post-surgery care, so that you can be as prepared as possible when considering cataract surgery. 

So let’s dive into cataract coverage under Medicare. Your eye health awaits!

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What Is Medicare?

Let’s go back to basics, before we try to dig into the specifics. Medicare is a federal health insurance for those that are aged 65 and older, or those who qualify earlier if they have certain disabilities or End-Stage Renal Disease. 

Medicare is broken into four parts:

  • Part A: Hospital insurance (inpatient hospital stays, hospice care, skilled nursing facilities, and home health care)
  • Part B: Medical insurance (doctor’s services, outpatient care, medical equipment, and preventative services)
  • Part C: Medicare Advantage 
  • Part D: Prescription drugs

Everyone decides which parts to enroll in. Many people choose either Original Medicare or Medicare Advantage:

  • Original Medicare: Combines Part A and Part B, but you can also add Part D. Original Medicare involves an annual deductible, and then usually 20% of the cost of the Medicare-approved service. 
  • Those on Original Medicare can also get MediGap, a supplemental insurance policy that helps pay for your out-of-pocket costs on Medicare.
  • Medicare Advantage: This is Medicare-approved insurance from a private company and bundles Parts A, B and usually D together. It also often includes even more, like vision, dental and hearing services. Costs can vary by plan. 
  • You can find more about the pros and cons of a Medicare Advantage plan here.

You can also maintain other health insurance plans at the same time as Medicare, to get even more coverage and pay fewer out-of-pocket costs. 

Medicare is mandatory once you turn 65, and you can be penalized if you don’t enroll on time. However, you can delay enrollment if you have existing health insurance from another provider. 

Medicare Coverage for Cataract Surgery

Now that we have level set, we can dive into the question at hand: does Medicare cover cataract eye surgery?

The answer, fortunately, is yes. 

But what is cataract surgery? In brief, it’s an operation to replace a blurry eye lens with a clear artificial lens inside the eye. It’s one of the most common procedures in the U.S.; in fact, there’s roughly 3.7 million cases per year. 

This is why it’s so important that Medicare covers cataract surgery. However, there are a few considerations when it comes to Medicare and cataract surgery, which we’ll explore next. 

Find out more about what Medicare does and doesn’t cover here

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Cataract Coverage Under Medicare

Medicare covers cataract surgery, but it must be done using traditional surgery methods or using lasers. It also needs to be medically necessary, or it won’t be covered.  Cataract surgery falls under Part B, because it’s typically an outpatient procedure. If cataract surgery happened to take place in a hospital, it would be covered under Part A.  Original Medicare and Medicare Advantage handle cataract surgery differently. Here’s some key facts:
  • Medicare Advantage typically covers the same services and more versus Original Medicare, so if it’s covered under OM, it’s covered under MA.
  • Original Medicare allows you to have cataract surgery with any provider that accepts Medicare. Medicare Advantage allows you to have the surgery with a provider that’s in-network.
  • You likely need prior authorization for the surgery with Medicare Advantage, but not with Original Medicare. 
The good news is, whether you have Original Medicare or Medicare Advantage, you can have the cataract surgery you need.

The Cost of Medicare Coverage for Cataract Surgery

Cost is always an important factor, so let’s explore the costs associated with cataract surgery under Medicare. 

Again, depending on which form of Medicare you have, your costs are going to look a little different. 

  • Original Medicare: Part B covers 80% of the cost and you pay the other 20% (after you’ve hit your annual deductible). This works out to anywhere from $316 to $524 (per procedure and per eye), depending on where the surgery takes place and how complex the procedure is. 
  • Medigap: If you have Medigap coverage, this usually covers the other 20% co-insurance. This means the procedure might not cost you anything, after you’ve paid your annual deductible and premiums. 
  • Medicare Advantage: You may need to pay a copay for the provider, as well as a facility copay. These can vary depending on your individual plan. 

If you want to know exactly how much you’ll need to pay, you can do so by looking up the procedure code through Medicare to find out. You can also contact the provider and speak to their billing department about costs.  

Note, if you can find a provider that takes Medicare assignment, you’ll save the most money. This means the provider accepts the amount that Medicare provides for the service and they don’t charge more than that (aside from your deductible and coinsurance). 

If you have other health insurance through your work or your partner, you might see your out-of-pocket costs drop to zero by doubling up on coverage. And if you find there are gaps in your Medicare coverage, you can absolutely take out a separate health insurance policy to help fill in those gaps. You can get access to free quotes here to browse your options. 

What Happens After Cataract Surgery?

Once you have had cataract surgery, you might need more care and it helps to know what you’re covered for. After the surgery, you will have a follow-up appointment with the doctor to ensure there are no complications or issues from the surgery. This appointment is usually covered under the cost of the surgery. 

However, if there are complications and you do need more care, Medicare will also typically cover those costs, aside from your coinsurance. If you’re prescribed eye drops or antibiotics, these would be covered by Medicare Part D.

You will also be entitled to a pair of glasses with standard frames or a pair of contact lenses after your cataract surgery. Medicare covers 80% of the cost of those, and you would be responsible for the other 20%. Any upgrades to those glasses would be paid by you, such as progressive lenses. 

Going forward, your Medicare will pay for costs relating to eye disease or eye injury, but routine eye exams are not covered, unless you have vision care under Medicare Advantage. 

Key Takeaways: Cataract Coverage Under Medicare

Cataracts affect so many Americans, so having cataract surgery covered under Medicare can be a relief. The good news is that if you have Part B coverage or Medicare Advantage, your cataract surgery will be covered. It won’t be completely free, as you will have to pay for part of it, but it becomes a lot more affordable.

This is one of the reasons why it’s so important to enroll in Medicare when you can, as it can help you get the care you need when you need it. If you’re new to the U.S., check out our free handbook for insurance for helpful advice. 

But if you’re not yet age 65 or you want supplemental health insurance, we’ve got you covered. Click here for access to free quotes fast, so you can get the coverage you need. 

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Hollay Ghadery Hollay Ghadery is a writer and editor who is passionate about financial literacy as a means to personal fulfillment. Hollay has over 18 years of experience creating content about a range of topics related to personal finance, including insurance, investing, banking, and credit cards. When Hollay isn't writing, she's spending time with her four children, two dogs, and three goats.

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