Does Medicare Cover Cataract Surgery?

The answer is yes.  Medicare pays for certain cataract treatments, but how much it pays and how much you will need to pay varies. The first step is getting a diagnosis from your doctor.

Today, cataracts are more and more common among seniors. The statistic states that 20% of people aged 65 and up have or had a cataract. That increases to 50% by age 80. You may be wondering how Medicare covers cataract surgery?  Keep reading to get the answer or give us a call at 844-528-8688

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When will Medicare Cover Cataract Surgery?

Medicare will cover cataract surgery for people aged 65 or older. Under Medicare Part B, Medicare will also offer to pay for corrective lenses after surgery to implant an IOL.

Medicare will also cover one pair of prescription eyeglasses or contact lenses under your benefits.

Moreover, in case you are wondering, Medicare Part B also covers cataract surgery that is done using laser surgery.

The bottom line is that Medicare Part B will only pay out the Medicare-approved amount for your cataract surgery. You, however, will be responsible for the Part B deductible (if not already met) and the 20% copay unless you have a Medicare Supplement plan or Medicare Advantage plan.

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What are Cataracts?

In the past, cataracts were a natural part of aging. They started with a thin clouding of your eye’s natural lens and eventually progressed to a stage where your vision became blurry.

But with breakthrough advances in ophthalmology, cataracts can be removed from your eyes through a surgery called a “cataract-removal surgery.” This is a common procedure that many people undergo in their 40s, 50s, and 60s.

If you experience these symptoms, it may be time for you to get your eyes checked. Cataracts can make you see things in a blurry or foggy way. They can also affect your perception of colors and sunlight, or other symptoms may include double vision or sensitivity to light.

Treatment for Cataracts other than Surgery

Your doctor may not recommend surgery if your cataracts are not too severe. In this case, they may prescribe new prescription glasses or contacts, anti-glare sunglasses, or a magnifying glass.

If your doctor suggests that surgery is not warranted and recommends non-surgical treatment, Original Medicare will not cover the treatment. But the good news is that some Medicare Advantage Plans (Medicare Part C) will include separated vision benefits that will significantly reduce your out-of-pocket expenses.

Are There Different Types of Cataract Surgery?

There are four types of cataract surgery that you are likely to be confronted with:

  • Laser Cataract Surgery – Laser surgery involves using a laser to make the incision on the eye rather than the surgeon using hand-held tools. Laser surgery is much more advanced and much more precise than other types of cataract surgery and as a result, it is more expensive.
  • Extracapsular Cataract Surgery – When performing extracapsular surgery, the surgeon removes the natural eye lens and leaves a part of the posterior lens in place. By using this surgical method, the surgeon will implant an artificial IOL (Intraocular Lens) without making major incisions.
  • Intracapsular Cataract Surgery – Intracapsular is generally the least common type of cataract surgery because it comes with a higher risk of complications. Using the intracapsular approach, your eye lens and the entire eye lens capsule are removed and replaced with an intraocular lens.
  • Phacoemulsification Cataract Surgery – This is the most common procedure for cataract surgery. During this type of surgery, your ophthalmologist will remove the cloudy lens and then replace it with an intraocular lens implant.

Which Parts of Original Medicare Cover Cataract Surgery?

Cataract surgery is usually an outpatient procedure, which means that Medicare Part B covers it. Medicare usually pays 80% of the total costs, consisting of both the procedure and facility charges subject to your deductible, if any.

Although Medicare Part B does not typically cover prescription glasses, they do make an exception for one pair of glasses or contact lenses after the cataract surgery is completed.

You should, however, confirm your remaining Part B deductible, if any, to determine your final out-of-pocket expenses of having cataract surgery.

Although most patients are not generally required to stay in the hospital overnight after cataract surgery, if an overnight stay is required, your Medicare Part A will cover the additional costs for admission.

How to Reduce Your Out-Of-Pocket Costs for Cataract Surgery

If you are like most seniors and have enrolled in a Medicare Supplement plan, all plans except for Plan K and Plan L will cover 100% of your Medicare Part B coinsurance requirement but only Plan F will cover your Part B deductible.

Medicare Supplement Plan K and Plan L cover less than 100% with Plan K paying 50% and Plan L paying 75% of the Medicare Part B coinsurance requirement.

If you have opted for a Medicare Advantage Plan (Medicare Part C) rather than a Medicare Supplement, most Medicare Advantage Plans will pay for some or all your cataract surgery plus most plans contain additional coverage for eyeglasses (if needed ) every one or two years in the future.



Find a Medicare Supplement Plan that is Right for You

Now that you’ve learned more about what Medicare Part B will and will not pay for cataract surgery, you should contact an experienced Medicare professional on the Medicare Solutions Team.

Our Medicare Solutions Team is prepared to answer any questions you might have about insurance coverage for cataract surgery or other medical procedures and help you choose a plan that is right for you and at a cost that will fit your budget.

Important Note:  You must continue to make your Medicare Part B premium even when you have enrolled in a Medicare Supplement Plan (Medigap) or a Medicare Advantage plan (Medicare Part C).

Frequently Asked Questions

What are Cataracts?

Cataracts are a cloudy area that forms in the lens of the eye, leading to vision problems.

Do Medicare Advantage Plans Cover Cataract Surgery Costs?

Medicare Advantage plans may cover some of the costs associated with cataract surgery, but it’s important to check your specific plan for coverage details.

How Much Does Cataract Surgery Cost with Original Medicare?

Original Medicare typically covers a portion of the cost of cataract surgery, but you may still be responsible for deductibles and coinsurance.

What are Intraocular Lenses (IOLs)?

Intraocular lenses are artificial lenses implanted in the eye during cataract surgery to restore clear vision.

Does Medicare Cover Routine Vision Care?

Medicare generally does not cover routine vision care, such as eyeglasses or contact lenses, unless they are medically necessary.

Will Medicare Cover Laser Cataract Surgery?

Medicare may cover laser cataract surgery if it is deemed medically necessary by your healthcare provider.

What is the Difference Between Medicare Advantage and Medicare Supplement Plans?

Medicare Advantage plans replace your original Medicare coverage, while Medicare Supplement plans work alongside original Medicare to help cover out-of-pocket costs.

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