Is Cataract Surgery Covered by Medicare?
Medicare does cover some of the costs of cataract surgery. Here is how to find out what your out-of-pocket expenses will be.
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Medicare covers 80% of the cost of traditional and laser cataract surgery
Your doctor must deem the procedure medically necessary
Medicare Supplement plans can help cover out-of-pocket costs
If you are one of the 25 million Americans who have cataracts, here is some good news. Once enrolled in Medicare Part B you are entitled to coverage for cataract surgery as long as your doctor deems the surgery medically necessary and accepts Medicare plans.
Medicare will cover:
Removal of the cataract
Replacement with basic intraocular lens implant
One set of prescription eyeglasses or contact lenses after the surgery
While Medicare covers the basic intraocular lens implant, it does not cover extra costs associated with advanced intraocular lens implants. If an advanced implant is needed, the cost will be passed on to you. Your eye doctor will tell you what type of implant is needed.
Original Medicare does not usually cover eyeglasses or contact lenses, but they will cover one pair after cataract surgery.
How Much Will I Have to Pay for Cataract Surgery?
It is important to keep in mind that the cost of any surgery can vary based on a variety of factors specific to the patient, physician, or facility.
However, researchers estimated in 2014 that the cost for single eye cataract surgery would be around $2,700, while the cost for cataract surgery for both eyes would be around $5,200. Based on this estimate, you can see how the cost would be distributed in the table below:
One eye surgery
Two eye surgery
Amount covered by Medicare (80%)
Amount out-of-pocket (20%)
If these fees still seem like too heavy a burden for out-of-pocket costs, you may want to enroll in a Medicare Supplement Plan for help covering such costs.
Should I Enroll in a Medicare Supplement Plan?
Medicare Supplement plans, also known as Medigap, are private insurance plans that help "fill in the gaps" of Medicare. They may cover deductibles, copayments, and other out-of-pocket costs that Original Medicare does not.
There are 10 Medigap plans, which are standardized and labeled by a single letter, ranging from A-N (A, B, C, D, F, G, K, L, M and N). What these plans cover remains the same no matter where you buy your plan (the exceptions occur in Minnesota, Massachusetts, or Wisconsin).
Eight of the 10 Medigap plans cover 100% of Medicare Part B coinsurance (this is the 20% that would be left for you to pay out-of-pocket if you were to have cataract surgery). Only Plans K and L do not cover this expense.
What Are Cataracts?
When you have a cataract, it means that the lens of your eye has become cloudy, which can cause you to experience blurry vision. Simply explained, it is sort of like trying to see out of a foggy or dusty car windshield. Along with blurred vision, you might experience double vision, or have trouble seeing at night, have sensitivity to light, or see halos around lights, among other symptoms.
Aging is the most common cause of cataracts, and age-related cataracts develop slowly over time. Other health issues, such as diabetes, smoking, previous eye injuries, eye damage from overexposure to the sun, or treatment with certain medications can sometimes speed up the development of cataracts.
What to Do if You Think You May Have Cataracts
If you are wondering whether you have cataracts, you should make an appointment with an eye doctor for a comprehensive eye exam. This involves taking a series of tests that will include having your pupils dilated.
If you are diagnosed with cataracts, be sure to schedule an eye exam each year thereafter to monitor the progression of your cataracts. You should also protect your eyes from damage from the sun by wearing sunglasses outdoors. If you are a smoker, your doctor will most likely advise you to quit smoking as well.
Keep in mind that Original Medicare does not pay for routine vision care, so you will need to pay for this out-of-pocket or find a Medicare Advantage plan that offers routine vision coverage.
Over time, if left untreated, cataracts can cause increased loss of vision and even blindness. However, if they are not bothering you much, you may just need an updated prescription for your eyeglasses. Ask your eye doctor what course of action is right for you.
What Does Cataract Surgery Entail?
Fortunately, cataract surgery tends to be very successful. In this outpatient surgery, an ophthalmologist removes the cloudy lens and replaces it with a clear, artificial lens (known as an intraocular lens implant). A patient's vision can become cloudy again after some time, and if this occurs, a laser surgery may then be needed.
As mentioned before, cataract surgery is covered by Medicare Part B if your physician has deemed it medically necessary and accepts Medicare plans. Medicare Part B will cover 80% of the cost, while the remaining 20% will be yours to cover out of pocket. To cover out-of-pocket costs, you may consider a Medicare Supplement Plan, many of which will cover the remaining 20% of surgery costs.
If you have cataracts and need eye surgery, you can have peace of mind knowing Medicare covers some of the procedure. You should be aware, however, that it does not cover everything, and a Medicare Supplement plan might not pay for all of your expenses either.
To make sure you are making the best decision for your health and budget needs, speak with a licensed Medicare insurance expert who can help answer any additional questions you may have.
Courtney Schmidt is a medical communications professional and clinical pharmacist with pediatric and adult hospital experience.