Does Medicare Cover Cataract Surgery?

Cataract Surgery and Medicare

Does Medicare pay for cataract surgery? The short answer is yes. Medicare covers certain medically necessary services, such as cataract surgery. Cataract surgery is performed by an ophthalmologist. Ophthalmologists are eye doctors with advanced medical and surgical training. Your cost and coverage will depend on the option you selected as your primary. Is Original Medicare or Medicare Advantage your primary?

Original Medicare (Medicare Part A and Medicare Part B)

If you have Original Medicare, the services are covered under Medicare Part B. Original Medicare is sometimes referred to as “Traditional Medicare”. Original Medicare will provide coverage for the cataract to be removed and the implanting of the basic lens. In addition, original Medicare will cover one set of prescription eyeglasses or one set of contact lenses after the surgery.

Since cataract surgery is a medically procedure, original Medicare will cover the cost of the surgery and the cost of the intraocular lens (IOL) implanted during the operation. OriginalMedicare covers the basic lens implants, but it does not cover more advanced implants. We recommend that you discuss your procedure with your provider before the surgery so that you understand what costs will be your responsibility.

Who will perform your surgery?

Since original Medicare is your primary you may use ANY medical provider that accepts Medicare. The decision is totally up to you as to who performs your surgery.

Medicare Part B also covers the following when it comes to cataracts:

Your eye exam to diagnose serious vision problems
Pre-surgery eye exams
Anesthesia during surgery
Removal of cataracts
Basic lens implants
One pair of prescription eyeglasses or contact lenses after surgery
Up to one year of follow-up

Medicare Advantage

Medicare Advantage Plans cover the same services as Original Medicare, but the costs and conditions may differ. If you have a Medicare Advantage Plan, your plan may have different rules. Some services may only be covered in certain settings or for patients with certain conditions.

Medicare Advantage plans are through private companies. This means things such as copays, coinsurance and networks vary from plan to plan. Your Medicare Advantage plan may also limit available providers to those within its network.

Who will perform your surgery?

That will depend on your plans network. Your Medicare Advantage plan may limit available providers to those within its network.

We highly recommend reviewing your summary of benefits or talking to a representative to understand what your options will be through your Medicare Advantage Plan.

Your Out of Pocket Cost for Cataract Surgery

If your primary coverage is Original Medicare and you have no supplemental coverage, then your responsibility will be 20% of the Medicare approved rate. In addition to this 20%, you will also have to pay the Medicare Part B deductible.

If you have Original Medicare and a Medicare supplement (Medigap) plan as your secondary, then your total out of pocket cost could be zero.

Typically, if you have Medicare supplement Plan F, you would have no out of pocket costs.
With Medicare supplement Plan G, your total cost could be no more than the Part B deductible.
Medicare supplement Plan N would leave you paying the deductible and possibly a $20 copay.

Your cost with a Medicare Advantage Plan will be depend on the specifics of your plan. Advantage plan coverage varies and is not standardized. To find out your cost, you would need to talk to a representative for your particular plan.