Does Medicare Cover Cataract Surgery?

Yes, Medicare Part B (medical insurance) covers cataract surgery, but there are some important details to remember. First, you’ll need a qualified healthcare provider (such as an ophthalmologist) to diagnose and treat the cataract. Medicare will cover the cost of this exam and any related testing. Once your provider determines that cataract surgery is necessary, Medicare will cover 80% of the cost of the procedure and associated costs, such as anesthesia and the artificial lens that will replace the cloudy one in your eye.

What Types Of Medicare Plans Cover Cataract Surgery?

It’s worth noting that your coverage may differ slightly depending on your plan type. Some plans may cover a higher percentage of the cost, while others may require you to pay a higher copay or coinsurance.  Here is a breakdown of Medicare coverage options for cataract care:

Original Medicare

Medicare Part B covers expenses for cataract surgery performed in an outpatient facility, while Medicare Part A may cover a portion of the costs if hospitalization is required.

Medicare Supplement (Medigap) Plans

You can get additional coverage through a Medicare Supplement insurance plan if you have Medicare. These plans can help pay for out-of-pocket costs like deductibles, copayments, and coinsurance that Original Medicare doesn’t cover. With Medigap plans, you may also avoid costs for pre-op appointments, surgery, follow-up care, and one pair of corrective lenses (after you meet your deductible).

Medicare Advantage Plans

A Medicare Advantage plan covers Part A and Part B services and may include extra benefits such as vision coverage. Selecting a provider within your MA plan’s network could save you out-of-pocket expenses.

Bottom Line

In summary, if you’re dealing with cataracts, you can take comfort in knowing that Medicare coverage will cover most of the costs of cataract surgery – as long as you follow the correct procedures and understand the limitations of your coverage. As with any medical procedure, it’s important to talk to your doctor and insurance provider to understand your options and coverage before moving forward.

Articles sources: AARP On Cataract Surgery | Humana on Cataract Surgery

FAQ's

• How many cataract surgeries will Medicare cover for me?

  Medicare generally covers cataract surgery only once per eye per lifetime. So, if you develop cataracts in both eyes, Medicare will cover the cost of surgery for each eye – but once you’ve had the surgery on both eyes, you won’t be eligible for coverage again.

• Which cataract surgeries are not covered by Medicare?

  Medicare will only cover cataract surgery that is medically necessary and uses standard intraocular lenses. Medicare will not cover if the surgery is intended to correct vision caused by nearsightedness or astigmatism (known as “refractive lens exchanges”) or uses advanced technology lenses.