Cataract Surgery and Medicare

Does Medicare pay for cataract surgery? The short answer is yes. Medicare generally does not pay for routine eye care, but it will cover certain medically necessary services, such as cataract surgery. If you have Original Medicare, the services are covered under Medicare Part B

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.  I would recommend that you contact your Medicare Advantage Plan to learn how cataract surgery will be covered.

Original Medicare will provide coverage for the cataract to be removed and the implanting of the basic lens. The coverage is for intraocular lens implants. The function of this small clear disk is to assist your eyes with focus.  In addition, Medicare will cover one set of prescription eyeglasses or one set of contact lenses after the surgery.

Medicare covers the basic lens implants, but it does not cover more advanced implants.  If your medical provider recommends more advanced implants, you may have to pay some or all of the cost. It is vital that you discuss your procedure with your provider before the surgery so that you understand what costs will be your responsibility.

So, what are cataracts?  The Mayo Clinic defines a cataract as a clouding of the normally clear lens of your eye. This can effect one or both of your eyes.  The cause is unknown, but the breakdown of lens proteins and aging are factors that are contributing factors.  

Cataracts can affect your perception of colors, sunlight, and headlights.  It may seem like you are looking through a fogged-up window. You may even have symptoms that include blurred vision, dim vision, and sensitivity to light.

According to Wikipedia, Cataract surgery is the removal of the natural lens of the eye that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocular lens.

As stated above, cataract surgery is covered under your Medicare Part B.  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

The cost of your cataract surgery will depend on several factors. 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 as your primary and you have a Medicare supplement (Medigap) plan as your secondary, then your total out of pocket cost will be little to none.  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 see 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 by plan.  To find out your cost, you would need to talk to a representative for your particular plan.

After recovery, most individuals that have cataract surgery report seeing crisper and clearer images. Hopefully your improved vision will make things such as driving, reading, and writing much easier.