Does Medicare Cover Secondary Cataract Surgery?

Even after successfully removing a cataract in your eye/s, another one can still reoccur. It can happen again just weeks or months after the cataract-removal surgery.

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

Does Medicare Cover Secondary Cataract Surgery?

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

Original Medicare (Medicare Part A and Part B) provides coverage for secondary cataract surgery. The good news is that Medicare will provide coverage for as many cataract surgeries as you need. The requirement, however, is that your healthcare provider decides the surgery is necessary for your health.

Medicare will cover the two main types of cataract surgery which are:

Phacoemulsification
Extracapsular

Along with the cataract surgery, Medicare also covers lens implantation and a pair of prescription eyeglasses or contact lenses after surgery.

Medicare Part A will cover cataract surgery if you get the surgery in a hospital or an inpatient setting.

Medicare Part B will provide cataract surgery coverage if it will be done in an outpatient setting such as clinics or outpatient hospital departments. Aside from that, Medicare Part B also covers doctor’s appointments, including appointments before and after the surgery.

Medicare Part B may also cover some prescription medications you may need due to your cataract surgery if they are medical costs.

Medicare Advantage plans (Medicare Part C) also provide coverage for secondary cataract surgery. They cover everything Original Medicare covers and some additional benefits. However, out-of-pocket costs will vary depending on the plan provided by the plan providers.

Medicare Part D will provide coverage for certain prescription drugs that you may need after your cataract-removal surgery. If your medication is not on the approved lists, Medicare Part D may not cover it.

How Much Does Secondary Cataract Surgery Costs?

Cataract surgery ranges between $3,600 to $6,000 per eye. The costs of cataract surgery may differ depending on certain factors, one of which is the type of cataract surgery you will be having.

How Does Secondary Cataract Occur?

During cataract surgery, the doctor will remove a large portion of the lens capsule in the front of the lens. This allows the doctor to access the cataract (or the cloudy lens) and remove and replace it with a clear intraocular lens or known as IOL.

The surgeon will place the IOL right in front of the posterior portion of the lens capsule. In some cases, weeks or months after the cataract surgery, the posterior lens capsule becomes cloudy. This is the secondary cataract or also known as posterior capsular opacification or POC.

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.