Does Medicare Cover Cataract Surgery?

Written by: 
Matt Kiggins
Last updated: 
July 20, 2023

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.

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FAQ

Yes, Medicare Part B covers pre-and post-op care related to cataract surgery. This includes doctor visits, diagnostic tests, and medications.

Medicare will not cover cataract surgery if it is not deemed medically necessary or if you choose to have a multifocal or astigmatism-correcting lens implanted. If you select one of these lenses, you will be responsible for the additional cost.

Cataract surgery typically takes about 10 to 20 minutes. Usually, the entire process, from pre-operative preparations to post-operative care takes about 2 to 3 hours.

Cataract surgery is not painful, as the eye is numbed with anesthetic drops before the procedure. Some patients may experience mild discomfort or pressure during the operation, but this usually goes away shortly after the surgery is complete. After the surgery, you may experience some initial irritation in your eye; however, this should subside after a few days.

You should not drive on the day of your cataract surgery. After the procedure, you may experience blurry vision and light sensitivity, which can make it unsafe to drive. Most ophthalmologists recommend waiting at least 24 hours after the surgery before resuming any activities that could be dangerous if your vision is impaired. It's also highly recommended to avoid driving until you've followed up with your eye doctor.

Matt Kiggins
Senior Editor
SimpleAdvisor.com

For over 15 years, Matt Kiggins has been the senior editor at Simple Advisor, giving detailed advice on Medicare, life insurance, and dental coverage to thousands of clients in more than forty states. His demonstrated expertise in assisting people with their health plan selection is remarkable — it’s evident that he stands out among competitors as the go-to source for knowledge and support.

Matt holds a resident 2–15 Florida Health & Life (Including Annuities & Variable Contracts) Agent License in Florida, his state license number is P116762 (Issued 10/1/2007).

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Matt Kiggins
Senior Editor
SimpleAdvisor.com
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