Does Medicare Cover Cataract Surgery?

Yes, Original Medicare Part B does cover cataract surgery if it’s done using traditional surgical techniques or lasers. Medicare Part B is the part of Medicare that covers doctor visits, outpatient services, and medical procedures. Cataract surgery is typically performed on an outpatient basis and is considered a medical procedure, which is covered by Medicare Part B.

It is important to note that there may be additional costs that you have to pay. Medicare Part B covers 80% of the cost of cataract surgery, and you are responsible for the remaining 20%. Additionally, if you have a Medicare Supplement plan, it may cover some or all of the remaining 20%. It is important to determine your out-of-pocket costs with your Medicare plan.

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Are There Any Limitations?

It is important to note that certain limitations to Medicare coverage for cataract surgery exist. Medicare Part B will only cover cataract surgery if it is considered medically necessary. This means that if you have cataracts that are not causing significant vision problems, Medicare will not cover the surgery.

Additionally, Medicare will only cover standard cataract surgery with a mono-focal lens. You will be responsible for the additional cost if you choose to have a different type of lens implanted, such as a multifocal or astigmatism-correcting lens.

How Much Does Cataract Surgery Cost?

Cataract surgery costs vary depending on the surgeon and facility, but you can expect to pay between $2,000 and $4,000 per eye without Medicare or other insurance. Medicare Part B will cover 80% of this cost when using Medicare approved providers. Medicare’s 80% as well as your 20% coinsurance amount is based on the Medicare approved amount for each procedure which is often significantly less than one would pay without insurance. To find out the amount you have to pay from your own pocket for cataract surgery, please consult your medical provider prior to scheduling your procedure.

What If I Have A Supplement Or Advantage Plan?

If you are enrolled in a Medicare Supplement or Advantage plan, it may provide additional coverage for cataract surgery and vision care.

Medigap Plan

Medicare Supplement plans can provide additional coverage for cataract surgery, helping to reduce the out-of-pocket expenses associated with the procedure. Medicare Part B covers 80% of the cost of standard cataract surgery with a mono-focal lens, leaving beneficiaries with 20% of the cost out of pocket. Having a Medicare Supplement insurance plan can cover part or all of that 20% coinsurance amount depending on the plan selected.

Advantage Plan

Medicare Advantage plans (also known as Part C) can also provide coverage for cataract surgery. Coverage specifics vary from plan to plan, so you should check with your insurer to determine the exact coverage. Generally speaking. However, Medicare Advantage plans will provide at least the same coverage as Original Medicare Part A and B. You may also be responsible for paying a premium and/or copayment or coinsurance for your services.

Bottom Line

In conclusion, Medicare does cover cataract surgery, but there are some out-of-pocket costs and limitations to be aware of. Medicare Part B will cover 80% of the cost of cataract surgery, but you will be responsible for the remaining 20%. Additionally, Medicare will only cover standard cataract surgery with a mono-focal lens if it is considered medically necessary. If you have any questions about Medicare coverage for cataract surgery, be sure to talk to your eye doctor and Medicare provider.