Does Medicare Cover Cataract Surgery?

If left untreated, a cataract can lead to vision loss. Unfortunately, a cataract rarely shows any symptoms or signs in its early stages. That makes it difficult to know if you have one or not.

Routine eye exams are the best way to catch them early. Now, Medicare does not cover routine eye exams. But what about cataract removal surgery?

Well, that question – “Does Medicare cover Cataract Surgery?” – is a common one that many people have. In this article, we answer the question in clear, plain English. You will also find the average costs of cataract surgery, as well as other helpful info.

Does Medicare Cover Cataract Surgery?

The short answer is yes; Medicare will cover the cost of cataract surgery. But not 100% of the time. As is often the case with Medicare, certain conditions must be met in order for Medicare to pay for your cataract surgery. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) will cover cataract surgery costs. The main condition being that your doctor finds the surgery to be medically necessary. Original Medicare provides coverage for both traditional and computer-controlled laser cataract surgeries.

Aside from the procedure itself, Original Medicare also provides coverage for an intraocular lens implant and a pair of corrective eyeglasses. Coverage for corrective eyeglasses after cataract surgery falls under Medicare Part B.

Most of the time, patients who undergo cataract surgery do not have to stay in a hospital. However, in some cases, there are complications which will require the patient stay in the hospital. In situations such as these, coverage is provided by Medicare Part A.

Coverage for cataract surgeries is mostly provided by Medicare Part B. This is because they usually take place in an outpatient setting.

After the cataract surgery, Medicare Part B will provide coverage for intraocular lens implants, or IOL implants. But it will only cover certain types of IOL implants.

Once approved, Medicare Part B will cover 80 percent of the costs of your cataract surgery.

Medicare Advantage plans (Medicare Part C) also provide coverage for cataract surgery. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and how much the out-of-pocket costs will vary depending on the specifics of your plan.

How Much Does Cataract Surgery Cost?

Cataract surgery typically costs somewhere in the range of $3,000 to $5,000 per eye. The average cost of cataract surgery in the U.S.is $3,500 per eye.

What Is Cataract Surgery?

The normal lens of the eye is clear. However, if the lens is cloudy, that may be a sign that you have a cataract.

If you undergo cataract surgery, the surgeon will remove the lens of your eye. Most of the time, the surgeon will then replace it with an artificial lens.

There are two main types of cataract surgeries, Traditional cataract surgery is where the surgeon uses a scalpel to make a small incision in the eye in order to clear up the cataract. In laser cataract surgery, the laser makes the incision and is used to clear up the cataract.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.