Yes, Medicare covers cataract surgery if your doctor deems it medically necessary. When cataracts are present in both eyes, you may need to get the surgery on both eyes, which is performed separately during different visits. Medicare typically covers both surgeries.
What Part of Medicare Covers Cataract Surgery?
Most cataract surgeries today are performed on an outpatient basis, which means they’d be covered under the Medicare Part B plan. Should your surgery require an inpatient stay for any medically necessary reason, it would need to be covered under Medicare Part A.
If you have a Medicare Advantage (or Part C) plan, the plan at minimum must cover everything that Parts A and B of original Medicare would cover. That means a medically necessary cataract surgery would be covered.
How Much Does Medicare Pay for Cataract Surgery?
Coverage under Medicare Part B is usually 80%, which means you would be responsible for 20% of the cost after your Medicare Part B deductible. In 2021, the Medicare Part B deductible is $203 per year.
According to Better Vision Guide, the average cost of cataract surgery is around $3,500 per eye. If you haven’t met any of your deductible, the costs for such a surgery would break down as follows:
- $203 deductible, which is your responsibility
- 20% co-pay after the deductible totaling $659.40, which is your responsibility
- $2,637.60 paid by Medicare
Obviously, this is a hypothetical example. How much Medicare pays and how much you might end up owing for a cataract surgery yourself depend on specific factors such as your plan, how much the provider charges and whether there are other treatment expenses. Always ask your provider about charges and options for paying ahead of time, and consult your benefits paperwork to understand what your insurance might cover.
It’s also important to note that Medicare Advantage plans have different deductibles and co-pays. Consider the details of your plan to best estimate your costs.
Does Medicare Pay for Eyeglasses With Cataract Surgery?
Corrective lenses are not typically covered by Medicare, but there are some exceptions. One of those exceptions is if you need eyeglasses or contact lenses after you get a certain type of cataract surgery. In those cases, Medicare Part B may cover one pair of glasses or one pair of contact lenses. Co-pays and deductibles would apply here too.
Medicare Supplemental Insurance and Cataract Surgery
If you have Medicare supplemental insurance, also called Medigap coverage, it may cover the costs of cataract surgery that are left after Medicare pays. These plans are designed to reduce the out-of-pocket costs associated with Medicare deductibles and co-pays.
Make Sure You’re Covered
If you don’t have a Medicare plan or supplemental plan and think you’re eligible, take time to find out more today. Before you undergo a surgery of any type, you may want to ensure you’re covered by a Medigap plan, for example, to substantially reduce your costs.
