Does Medicare Cover Cataract Surgery?
Key Takeaways
- Typically, Medicare Part B covers cataract surgery and corrective lenses after your surgery.
- Medicare does not cover all the costs of your cataract surgery but will cover a portion after your Part B deductible.
- Inpatient services, while rare, will typically be covered by Medicare Part A.
Cataract surgery, if medically necessary, is covered by Medicare Part B whether you have Original Medicare or a Medicare Advantage plan.
What is a cataract? A cataract is the clouding of the eye’s natural lens. Medicare will cover the surgery, related costs and one corrective lens device (a pair of eyeglasses or contacts) after surgery.
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Does Medicare Cover Cataract Surgery?
The Part B portion of your plan provides Medicare coverage for cataract surgery. If inpatient treatment is a result of surgery, Part A might cover the treatment. Part B will pay for corrective lenses if you receive an intraocular lens to replace your eye’s natural lens (which is usually the case).
If you have switched to Medicare Advantage (Part C), your plan may offer vision coverage for your cataract concerns.
According to the National Eye Institute, more than half of Americans age 80 or older either have cataracts or have had cataract surgery. The government-sponsored institute estimates that cataract surgery improves eyesight in 9 of 10 cases, making it necessary to improve quality of life.
How Much Does Medicare Pay for Cataract Surgery?
Cataract surgery costs might be a financial burden. Still, as is standard with Part B, Medicare pays 80 percent of the cost of cataract surgery after you pay your annual deductible. You are responsible for paying the remaining 20 percent in coinsurance.
If you have Original Medicare for Part A and Part B coverage, adding a Medicare Supplement plan can help you with out-of-pocket costs like coinsurance.
In the rare instances where the surgery is considered inpatient and qualifies for Part A coverage, Part A will cover the hospital bill after you pay your deductible for the benefit period.
Does Medicare Pay for Laser Cataract Surgery?
If you require cataract surgery, Medicare will cover the procedure. Medicare will pay the same amount for the surgery whether your Medicare-approved doctor uses a laser or not. If there is a cost difference between the two procedures, you will be responsible for additional costs because Medicare won’t pay more for a more expensive procedure.
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Does Original Medicare Pay for Cataract Surgery?
With Original Medicare, Part B usually covers cataract surgery. Typically, you won’t have coverage for your surgery with only Part A.
If you have Original Medicare (Part A and Part B), you have the option to add a Medicare Supplement plan to help with your out-of-pocket costs like coinsurance. If you have a Medicare Advantage plan with vision benefits, your plan may provide more coverage than Original Medicare. However, Medicare Advantage plans vary, so it’s important to know what each plan covers.
Sources
- At a glance: Cataracts. NEI.NIH.gov.
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