Does Medicare Cover Cataract Surgery? A Clear Look at Coverage

Half of Americans by age 80 either have cataracts or have had cataract surgery.1 Determining if Medicare covers the procedure is an important step in determining your coverage, options, and potential costs.

Does Medicare Cover Cataract Surgery?

Cataract surgery is covered by Medicare when your medical provider performs the procedure using traditional surgical techniques or lasers. If your treatment includes laser surgery, premiumpremiumThe amount you pay for your health insurance every month. lenses, and/or multifocal lenses, you could incur higher out-of-pocket costsout-of-pocket costsYour expenses for medical care that aren’t reimbursed by insurance.. For these services, Medicare may charge you the difference between the covered amount and the additional costs your surgeon will charge.

Here are some basic factors regarding your Medicare coverage that you should keep in mind prior to cataract surgery:

• If your cataract surgery requires a hospital stay, you will need to pay your deductibledeductibleThe amount you pay for covered health care services before your insurance plan starts to pay. under Medicare Part A. Most of the time, though, cataract surgery doesn’t require hospitalization.
• Medicare Part B medical insurance will cover presurgical appointments and outpatient services post-surgery.
• Once you pay your deductible, you’ll receive 80% coverage from Medicare but will also still need to pay any copayments.
• If you have Medicare Advantage, check with your insurance company to confirm if there are any benefits">additional benefits.
• If you have a Medicare Supplement Plan, it may cover some of the out-of-pocket costs related to your cataract surgery.

What Does Cataract Surgery Cost?

Without insurance, the average cataract surgery cost is around $1,789 to $2,829 (depending on the type of facility you visit). With Medicare, the average cost is $357 to $565.2

A standard operation is typically considered medically necessarymedically necessaryHealth care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine. by Medicare and will be covered. However, if you need a more advanced procedure, there may be additional costs above what Medicare covers. The total cost of your procedure will depend on the type of lens used, the technology used, and the surgeon’s charges. Check with your provider before your procedure to see what costs are covered.

Estimating Your Costs for Medicare Cataract Surgery

The services you need can vary, so the costs will depend on your specific circumstances. But you can get an idea of your estimated cost by following these steps:

1. Find out whether you’ll be inpatient or outpatient for the surgery. This impacts how you will pay.
2. Verify that the doctor and facility you’ll use accept Medicare.
3. Ask your healthcare providerhealthcare providerA licensed person or organization that provides health care services.healthcare providerA licensed person or organization that provides health care services. what you should expect to pay for the surgery.
4. Find out which prescriptions you may need afterward. If you have Medicare Part D, check your formulary for the cost of these drugs.
5. Verify coverage with any additional insurance providers. For example, you might have benefitsbenefitsThe health care items or services covered under a health insurance plan. with Medicaid or a spouse’s employer.
6. Check your deductiblesdeductiblesThe amount you pay for covered health care services before your insurance plan starts to pay. or out-of-pocket limits. You’ll need to meet the deductible before your coverage begins. If you have an out-of-pocket limitout-of-pocket limitThe most you have to pay for covered services in a plan year., you won’t pay anything past that amount.

What Does Medicare Pay for After Cataract Surgery?

Medicare will pay for post-operative exams and a single pair of prescription glasses after your cataract surgery is completed.

How to Keep Your Additional Vision Care Affordable

Now that you know your cataract surgery may be covered, it’s a good time to consider your comprehensive visionvisionA health benefit that at least partially covers vision care, like eye exams and glasses.visionA health benefit that at least partially covers vision care, like eye exams and glasses. care. Many Medicare Advantage plans include vision coverage as part of the plan’s benefits. Additionally, senior vision insurancevision insuranceA health benefit that at least partially covers vision care, like eye exams and glasses. coverage is also available for those without Medicare Advantage plans. For even more convenience, there are also plans that combine vision, dental, and hearing coverage into a single policy.

Explore your options, compare coverage, and find a plan that suits your vision needs today with HealthMarkets.