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Medicare and Cataract Surgery Coverage

Cataract Surgery: Do You Need Vision Coverage?

No one knows what causes cataracts. Contributing factors include a breakdown of proteins in the lens of your eye and certain chemical changes in the body. As these are both associated with aging, and cataracts most commonly occur in adults over age 50, the condition is considered another part of the aging process.

Cataract graphic

Does Medicare Cover Cataract Surgery?

In word: Yes. The association between cataracts and age is one reason Medicare covers cataract surgery, even though it does not pay for most vision care. Your Part B benefit covers the surgery if your doctor uses either lasers or traditional surgical techniques.

Original Medicare coverage includes the removal of the cataract, an intraocular lens implant, and one set of corrective lenses (prescription eyeglasses or contacts) after your procedure. If your provider recommends an implant more advanced than the intraocular lens, Medicare may not cover that portion of the procedure.

Cataract surgery is covered under Medicare Part B’s outpatient services. If you have a Medicare Advantage (MA) Plan, talk to your provider about specifics. Of course, your MA plan covers everything Part B does, but conditions and costs vary per plan and provider.

What Are Your Costs for Cataract Surgery?

Your costs vary depending on a number of factors, including:

  • What your provider charges for the procedure
  • Whether you are inpatient or outpatient
  • Whether you have secondary insurance, such as a Medigap policy or an employer-sponsored plan
  • Whether you’ve already met your yearly deductibles

Talk to your provider – either your doctor or the healthcare facility – before the procedure to find out what they charge for both the surgery and any necessary aftercare. Until you know this, you cannot estimate your costs.

You can view your Medicare Summary Notice to determine whether you’ve already met your yearly deductibles. If you have not, you must pay your deductible amount before Medicare pays. In addition, you may have a co-payment.

How Can a Medigap Plan Help?

A Medigap policy helps cover some of the costs not covered by Original Medicare. These include co-payments, co-insurance, and deductibles.

If you have a Medigap policy (also known as Medicare Supplement Insurance), Medicare pays its share of the approved amount and then Medigap . If you have Medigap insurance and aren’t sure what it covers, talk to your provider.

Does Medicare Cover Corrective Lenses and Contacts?

Typically, Medicare does not cover corrective lenses. However, cataract surgery is an exception. If you require prescription glasses or contacts following your procedure, Medicare Part B helps pay for either one pair of standard frame eyeglasses or one set of contacts.

Does Medicare Cover Corrective Lenses and Contacts

Your costs include:

  • 20 percent of the Medicare-approved amount for corrective lenses
  • Any additional cost if you choose to upgrade the frames
  • Your Part B deductible if you haven’t met it yet

The supplier of your eyeglasses or contacts must in Medicare for coverage to apply.

Final Thoughts on Cataract Surgery and Medicare

Medicare covers a wide array of medical procedures, including cataract surgery. To understand your costs, talk to your provider to determine what they charge and whether that charge falls within the Medicare-approved amount.

If you have a Medigap policy, ask your provider about coverage, including the surgery, pre- and post-procedure treatment, and prescriptive lenses.

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