July 25, 2024

Drgreesh

Health Can Do

Does Medicare cover cataract surgery?

4 min read

Cataracts – a less than ideal part of getting older. More than half of Americans over 80 years old either have cataracts or have had corrective surgery to fix them. Left untreated, cataracts can interrupt your daily life, and in some cases, even lead to blindness. But the good news is that, for the most part, cataract surgery is painless, simple and safe.

While that sounds great on the surface, it’s hard not to wonder about cost. Will Medicare pay for cataract surgery? The short answer is, yes. Original Medicare doesn’t often cover routine vision services, but cataracts are covered if the procedure is considered medically necessary.

Let’s take a moment to talk through what parts of Medicare will cover cataract surgery, what types of procedures are covered and what that means for your overall out-of-pocket costs.

Parts of Medicare that cover cataract surgery

Different parts of Medicare offer coverage for cataract surgery, but it all depends on what kind of plan you have. Typically, cataract surgery is done on an outpatient basis, which is where Original Medicare (Part B) or Medicare Advantage (Part C) come in to play. Here’s what you need to know.

Medicare Part B coverage of cataract surgery

For those with Original Medicare, and whose cataract surgery has been deemed a medical necessity by a doctor, Part B will cover procedure costs – but you’ll still have some out-of-pocket costs. You can expect Medicare to cover around 80% of your overall surgery costs after you meet your deductible. This means that the remaining 20% would be your responsibility.

Medicare Part C (Medicare Advantage) coverage of cataract surgery

Medicare Advantage plans, offered by private companies, work as an alternative to Original Medicare.

Out-of-pocket costs with a Medicare Advantage plan depend on what kind of coverage you have, but you won’t pay any more than the 20% of the total that you’d pay with Original Medicare. It’s also important to note that with a Medicare Advantage plan, finding an eye doctor in your network will help keep costs low.

Medicare Cost plans are another type of private Medicare plan that can help pay for cataract surgery. Just like Medicare Advantage plans, if you have a Cost plan, you won’t pay more than a 20% coinsurance for cataract surgery.

Specific areas of cataract surgery that are covered by Medicare

The great news is that coverage isn’t just limited to your actual procedure. It includes almost all aspects of care surrounding your cataract surgery. Medicare will cover a portion of your initial eye exam, any additional exams you need pre-surgery, medicines, facility and provider services, up to a year of follow-up care and more.

Does Medicare cover glasses after cataract surgery?

While Medicare Part B doesn’t typically cover glasses or contacts, cataract surgery is an exception. If after your procedure you need additional corrective measures, Original Medicare and Medicare Advantage will cover the cost of one set of Medicare-approved glasses or contacts.

Some Medicare Advantage plans also offer enrollees a prepaid benefit card or an eyewear allowance that you can use on additional pairs of glasses or contact lenses. Depending on what vision benefits your Medicare Advantage plan offers, you may also have coverage on eye exams and checkups moving forward.

What type of lens does Medicare cover for cataract surgery?

Original Medicare and Medicare Advantage will cover a standard intraocular lens (IOL). This small disc replaces a natural lens that’s been blurred or clouded by a cataract. It can be implanted using basic surgical techniques or lasers.

Does Medicare cover YAG laser capsulotomy?

YAG laser capsulotomy is an outpatient procedure that some people will require months or even years after cataract surgery. If your vision gets cloudy again (which is sometimes referred to as a “secondary cataract”), this follow-up surgery can help restore it.

If considered a medical necessity by your doctor, Original Medicare or a Medicare Advantage or Cost plan will both help cover the costs of YAG laser capsulotomy – this includes any necessary exams, medicines and a year of follow-up care.

The cost of cataract surgery with Medicare

The average estimated cost of cataract surgery, without insurance, fluctuates – one eye is likely to cost anywhere between $3,000 to $7,000. This is a pretty significant cost range, because some have the procedure done in non-hospital surgical centers and some in hospital outpatient departments.

According to Medicare.gov, for an average extracapsular removal in 2022 (after Medicare has contributed), you can expect to pay around $361 for surgery done in an ambulatory surgical center or $573 for surgery done at a hospital outpatient department. However, it’s important to remember that these are estimates – additional fees may apply, and the total cost can change over time. Make sure to touch base with your Medicare plan representative if you have any questions so you can have a good idea of what you’ll have to pay.

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