Does Medicare Cover Cataract Surgery?

Does Medicare Cover Cataract Surgery?
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Does Medicare Cover Cataract Surgery?

Does Medicare Cover Cataract Surgery?
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Medicare doesn’t typically cover vision-related treatments, but it does cover cataract surgery. Here’s all you need to know about getting the treatment. 

A cataract is a common eye condition in which the lens becomes increasingly opaque, resulting in blurred vision.

Surgery is a common and effective way to treat the condition. The National Eye Institute reports that over half of those aged over 80 in the U.S. have undergone the procedure. 

If you’re suffering from cataracts, we have good news: the surgery is covered by Medicare. 

  • Medicare Part B covers cataract surgery.

  • Your plan covers 80% of the cost of the surgery, assuming you’ve met your deductible.

  • The actual price you pay depends on multiple factors.

Does Medicare Cover Cataract Surgery?

As an outpatient treatment, cataract surgery is covered by Medicare Part B—assuming your doctor decides that the surgery is necessary. Original Medicare covers both main types of cataract surgeries: phacoemulsification and extracapsular.

Medicare Advantage plans and Medicare Part C plans include everything you get in Medicare Part A and Part B. So these plans also cover cataract surgery. 

Your insurance covers most costs related to the procedure, including eye exams, anesthesia, the removal of cataracts, their replacement with a basic lens, a pair of prescription glasses or lenses for use post-operation, and a year of follow-up care. 

If you need a hospital stay—which cataract surgery doesn’t usually require—this should be covered by your Medicare Part A plan. 

Medicare Part A and Part B don’t cover prescription drugs. If you need to take medicine post-surgery, you’ll either have to pay for it yourself or need a Medicare Part D plan. 

This is another part of Medicare that helps cover the cost of prescription drugs, as well as shots or vaccines. Part D plans are run by private insurance companies. 

Does Medicare Cover Laser Cataract Surgery?

Cataract surgery can be performed with lasers or a scalpel. Some people may prefer to have the former type of procedure—even though it is more expensive. 

Medicare covers laser surgery at the same level as standard cataract surgery. But you will have to pay the added costs associated with laser treatment yourself.

What Type of Lens Does Medicare Cover?

Medicare covers basic monofocal IOL lenses. If you want a different type of lens—for example, multifocal or toric lenses—you’ll have to cover additional costs yourself. 

You’ll also have to pay for any additional surgical costs associated with the implantation of these lenses.

Does Medicare Cover Post Cataract Surgery Treatments?

Medicare covers your post-surgery exams and one pair of prescription glasses or contact lenses from a Medicare-enrolled supplier. It also covers up to a year of follow-up care.   

How Much Does Cataract Surgery Cost with Medicare?

In the case of cataract surgery, the amount you would pay depends on the cost of the surgery and your deductible. 

A deductible refers to the set amount you pay for health care services before your insurance begins to pay. For example, if you have a deductible of $1,500, you have to pay $1,500 before your insurance kicks in. 

Once you have met your deductible, Medicare covers 80% of the cost of standard surgery. 

To show you how the prices for cataract surgery can vary, let’s take a look at a real-world example:

Meet John 

John is a 68-year old man from Ohio. He has been struggling with cataracts for the last year. Without insurance, John’s cataract surgery will cost around $3,500 per eye. 

This will also depend on the surgeon’s pricing and factors like the technology used, the type of lens and whether or not he needs a hospital stay. 

However, John has Medicare coverage and has met his deductible. This means that Medicare will cover 80% of the cost of the standard surgery. 

Now, John’s cataract surgery will cost around $700 at the low end. 

If he had not met his deductible (the amount he had to pay for health care services before his insurance kicked in) he would have had to pay the full amount for the surgery, or pay an additional fee before his insurance started to cover the costs. 

Common Factors That Can Affect the Price of Surgery

  • The doctor that performs the surgery
  • Where you are located
  • Whether the surgery takes place in an outpatient surgical center or a hospital
  • Variances in the procedure (premium cataract surgery costs more)
  • Potential complications

Medicare Supplement Plans (also known as Medigap) are designed to help you cover the out-of-pocket costs associated with Medicare. 

The benefit of these plans is that they can reduce the amount you have to pay. The specifics will depend on your plan, but it may cover deductibles, copayments, and other expenses.

 

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Be sure to discuss the procedure with your doctor before committing to surgery. This will give you a complete understanding of the cost of the surgery.

Medicare Requirements for Cataract Surgery

Medicare only covers cataract surgery if your doctor recommends that it is medically necessary. This is usually the case when the condition makes carrying out everyday activities difficult.

You also need to ensure that the doctor you plan to undergo your procedure with accepts Medicare for payment.   

Non-Surgical Treatment

The effects of cataracts can be treated without surgery. This is most likely to be the case if your symptoms aren’t severe. 

Prescription eyeglasses, lenses, and anti-glare sunglasses can all help you improve your vision without the need to resort to surgery. Your doctor may recommend this treatment depending on the severity of the problem. 

Postponing the operation won’t harm the affected eye. Depending on how the condition progresses, you may never even need surgery.

Medicare Part A and B do not cover standard vision-related procedures. You’ll have to pay for prescription glasses out-of-pocket or with a relevant private insurance plan. 

Some Medicare Advantage plans may offer support for this type of treatment.

Medicare Significantly Reduces the Cost of Cataract Surgery

Medicare covers cataract surgery, but you’ll still typically end up with a bill following your procedure. The exact amount you pay will depend on the procedure specifics, your deductible, and more. 

Medicare Supplement Plans that are  bought through an insurance company can help reduce some of these additional costs. 

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