Does Medicare Cover Cataract Surgery?

October 30, 2023
October 30, 2023

Cataracts are an imperfect aspect of growing old. Over 50% of American adults have cataracts or have undergone corrective surgery to address this issue by the time they celebrate their 80th birthday. If left untreated, cataracts can cause serious disruptions to your daily life and even cause blindness. The good news is, however, for the most significant part, contract surgery is simple, safe, and painless. Although this sounds simple, it’s difficult not to think about the cost. Does Medicare cater for cataract surgery? The simple answer is yes. Ideally, Medicare doesn’t pay for vision care but may cover cataract surgeries if deemed medically necessary.

In this article, we’ll explore the parts of Medicare that cover cataract surgery, the procedures covered, and the costs you will need to cover out of pocket.

Parts of Medicare That Pay Expenses Related to Cataract Surgery

Basically, cataract surgery is an outpatient service, and that’s where Medicare Part A, Medicare Part B, and Medicare Part C come in.

If your doctor deems a cataract surgery necessary, Medicare Part B will cover around 80% of the overall surgery costs after you meet your deductible. Therefore, you will have to pay the remaining 20% from your pocket. If the procedure requires you to stay in a hospital, Medicare Part A, which is hospitalization insurance, will come into play.

With Medicare Part C, also called Medicare Advantage, the out-of-pocket costs depend on the type of coverage you have, but you will not pay over 20% of the total you would pay with original Medicare. With a Medicare Part C plan, finding an eye doctor in your network will help cut costs.

Medicare Cost plans can also help pay for cataract surgery. Like Medicare Part C, with a Cost plan, you will not cater for more than 20% of the total cost.

Areas of Cataract Surgery Procedure Covered By Medicare

Luckily, Medicare doesn’t only cover the actual procedure. It covers virtually all aspects of services and care associated with cataract surgery. Medicare will pay for a significant portion of your initial eye exam, any additional tests you may need before surgery, facility fees, medicine, and provider services for up to one year.

Basically, Medicare Part B doesn’t include the cost of contacts or glasses, but cataract surgery is an exception. If you need additional corrective procedures following the surgery, Medicare will pay for one set of approved contacts or glasses.

Medicare Part C also offers an eyewear allowance or a prepaid benefit card, which you can use to buy extra pairs of contact lenses or glasses. You may also get coverage on eye checkups and exams moving forward, depending on the benefits your Medicare Part C offers.

Original Medicare and Medicare Part C also cover a standard IOL (intraocular lens). This lens replaces the natural lens that a cataract has clouded or blurred. This lens can be implanted using lasers or basic surgical tactics.

In case your vision becomes cloudy again after the surgery, a follow-up procedure called YAG laser capsulotomy can help restore it. This is an outpatient procedure that you may need months or years after the surgery.

If your doctor considers YAG laser capsulotomy a medical necessity, Medicare Part C or Cost plan will cover the associated costs, including eye exams, medicines, and follow-up care.

Does Medicare Pay for Combined Cataract-Glaucoma Surgery?

If you have both cataracts and glaucoma, the doctor may treat them both during the surgery. However, Medicare may not pay for less-invasive glaucoma procedures.

How Much Should a Patient Expect to Spend on Cataract Surgery With Medicare?

According to Medicare.gov, cataract surgery in a surgery clinic or center costs around $1842 ($1101 in facility fees and $741 in doctor fees). Medicare covers $1431 of the total, which means you will pay $368 out of the pocket.

On the other hand, if you have cataract surgery in a hospital (outpatient department), the procedure will cost $2900 ($2159 in facility fees and $741 in doctor fees). Medicare will pay $2320, so you will pay $579. According to Medicare. Gov, these costs don’t include physician charges or other medical procedures that your doctor may deem necessary. In addition, these estimates will vary depending on the complexity of your cataracts and where you live. You may need more than one doctor, and thus, additional fees may apply.

Additionally, the cost of cataract surgery with Medicare varies greatly depending on your plan and the type of lens you need. To determine how much the procedure will cost, you will need to talk with your Medicare provider and eye doctor before the surgery.

What’s the Best Medicare Plan for Cataract Surgery?

Most Advantage plans pay for all costs of cataract surgery, but you need to find a hospital, surgery center, or physicians contracted with your specific plan.             

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