Does Medicare Cover Cataract Surgery?
As we age, it is common to experience some loss of vision. There are many causes for impaired vision, but if your vision becomes hazy or less colorful, you may have cataracts.
Although Original Medicare doesn’t cover vision care, Medicare does cover cataract surgery. In this guide, you’ll learn about what causes cataracts, the symptoms you may experience if you have cataracts, and how Medicare works to cover cataract surgery.
Key takeaways:
Original Medicare covers cataract surgery. If you only have Original Medicare, you’ll owe 20% of the cost of the surgery after you meet your Part B deductible.
If you have a Medicare Supplement plan, your out-of-pocket costs will be a lot less for the surgery.
Medicare Advantage plans have varying out-of-pocket costs. Check your plan details carefully to understand what you will owe for cataract surgery.
What are cataracts?
Cataracts are a clouding of the lens in the eye, which leads to blurred vision, difficulty seeing at night, and overall visual impairment. Cataracts are very common, in fact, over 50% of Americans over 80 years old either have cataracts or have had cataract surgery. Luckily, cataract surgery is common and highly effective in restoring clear vision.
Causes and symptoms of cataracts
There are a number of factors, both controllable and uncontrollable, that can cause cataracts. Some common causes include:
Age
Genetic disorders
Eye Injury
Smoking
Diabetes
Obesity
Exposure to U.V. lights
Eye Inflammation (also known as Uveitis)
There are also early warning signs to look out for so that you can seek early treatment. Common symptoms include:
Clouded and blurry vision
Squinting and headaches in response to bright light
Halos and glare in the field of vision
To reduce your risk of cataracts or mitigate some of the symptoms, it is recommended to stop smoking, limit exposure to UV light, and maintain a healthy body weight. Many causes of cataracts are unavoidable though, and cataracts are common. Luckily, Medicare covers cataract surgery.
Medicare cataract surgery coverage
Without health insurance, standard cataract surgery can cost between $3,000 - $6,000 per eye. Note: It’s common to perform surgery on one eye at a time to reduce risk of permanent vision loss. Medicare will cover your cataract surgery differently, depending on your type of coverage (Original Medicare, Medigap, and Medicare Advantage).
Original Medicare
Medicare Part A may pay some of the costs of the surgery if the surgery requires hospitalization. Medicare Part B covers 80% of your cataract surgery if your surgery takes place in an outpatient facility. Original Medicare doesn’t cover all of your medical costs—without a Medicare Supplement plan, you'll be responsible for the remaining 20% (your coinsurance).
Medicare Supplement Plans
Medicare Supplement plans fill the gaps left from Original Medicare. They’ll help you cover the 20% of out-of-pocket costs not covered. If you have a Plan G, for example, once you’ve met your Medicare Part B deductible, which is $240 in 2024, you’ll owe nothing for Medicare-covered services, including cataract surgery.
Keep in mind that neither Original Medicare nor Medicare Supplement plans provide coverage for routine eye care. Cataract surgery and other medical procedures involving the eye are the only types of eye services that they cover.
Medicare Advantage
Medicare Advantage plans (also known as Medicare Part C) must provide at least the same amount of coverage as Original Medicare. This means that if you have a Medicare Advantage plan, cataract surgery is covered, as long as your surgeon is in network. One of the drawbacks of Medicare Advantage plans is that they may require prior authorization for covered services, so be sure to check your summary of benefits to avoid surprise bills!
If you have a Medicare Advantage plan, it may also cover routine services for eye care. Check your plan details for details around coverage.
What type of lens does Medicare cover for cataract surgery?
Medicare covers standard intraocular lenses (IOLs). Medicare may not cover premium IOLs, which are newer and more expensive, and may come with a higher risk of complications. Talk to your healthcare provider to see if the conventional intraocular lens works best for you.
How does cataract surgery work?
During your cataract surgery, your ophthalmologist removes your clouded eye lens and replaces it with an artificial, intraocular lens. Most people remain awake for cataract surgery but are unable to see what their doctor is doing. You’ll also receive numbing medication to be sure you don’t feel anything during the surgery.
Immediately after cataract surgery, you may experience light sensitivity and itchiness, which should go away after 1-2 days. If you experience other problems, like vision loss, very red eyes, and bad pain that doesn’t go away, you should consult your doctor. Most people are fully healed after eight weeks, and your doctor will schedule followup appointments to check in on your healing progress and vision status.
Types of cataract surgery
There are a few different types of cataract surgery. Depending on the level of cataract severity or whether you have other eye conditions, your doctor may recommend a basic cataract surgery or a more advanced cataract surgery. The most traditional cataract surgery is called phacoemulsification, also known as small incision cataract surgery (SICS).
If necessary, you can also undergo laser cataract surgery, also called Femtosecond Laser-Assisted Cataract Surgery (FLACS). This procedure can be more precise, but is generally more expensive.
Medicare vision coverage after cataract surgery
Medicare may also cover many post-surgery services that are deemed medically necessary. Medicare Part D covers any eye drops, antibiotics, or other medications you need after getting cataract surgery.
Does Medicare cover eyeglasses or contacts after cataract surgery?
Medicare will cover one pair of eyeglasses or contact lenses that your doctor prescribes after cataract surgery. Make sure you visit a Medicare-approved eye doctor to receive your lenses. Double check that the frames or lenses you’re getting are approved by Medicare before making your purchase. Medicare only covers standard frames, so you’ll have to pay for any premium additions.
If you ever have any questions about your Medicare coverage, our licensed Medicare advisors can help! Whether you need help finding a plan that covers your healthcare needs at the lowest cost or need help understanding how your current coverage works, we’re here to help you get the best value from Medicare. Call us at 855-900-2427 or schedule a time to chat.