Does Medicare Cover Cataract Surgery?
While Original Medicare does cover the cost of cataract surgery, it may not cover advanced lens implants or additional glasses. Also expect out-of-pocket costs.
Medicare covers cataract surgery if the surgery involves an intraocular lens implant. Medicare Part B will also cover one pair of glasses or contacts after cataract surgery.
A Medicare Supplement Insurance (Medigap) plan can help cover cataract surgery costs such as Medicare deductibles, copays, coinsurance and other out-of-pocket costs you typically are required to pay.
How Much Will Medicare Pay for Cataract Surgery?
Your inpatient or outpatient status is part of what determines how much of the cost is covered.
Medicare Part B covers certain diagnostic tests and the procedure itself. The Part B deductible is $226 per year in 2023. After you meet your deductible, you are typically responsible for paying a 20% coinsurance cost for covered services for the rest of the year.
Medicare Part A covers inpatient hospital costs if you are required to stay in a hospital for your cataract surgery. In 2023, the Part A deductible is $1,600 per benefit period. Coinsurance does not apply until day 60 of an inpatient hospital stay, which a beneficiary is unlikely to reach due to cataract surgery alone.
Cataract surgery is commonly performed in an outpatient setting, which is usually covered by Medicare Part B. If your procedure is approved by your doctor and the Medicare program, Medicare Part B will cover 80% of the surgery cost. You are responsible for paying for the remaining 20% coinsurance.
Medicare will help cover the cost of prescription glasses or contact lenses if your cataract surgery involved implanting an intraocular lenses. Medicare doesn't typically cover eyeglasses or other corrective lenses.
Medicare also covers the following vision care and cataract surgery costs:
Medicare will cover the cost of diagnostic eye exams, even if no major issues are found.
Medicare will cover some or all of the surgical procedures to repair the function of the eye due to cataracts. This includes cataract removal surgery.
Medicare will cover the cost of replacing your eye’s lens with basic intraocular implants.
The Medicare Part A and B deductibles, coinsurance and copayments will apply.
Medigap Can Help Cover Out-of-Pocket Cataract Surgery Costs
If you are 65 or older and experiencing problems with your eyes, it’s time to speak to a doctor about your vision. For beneficiaries covered by Original Medicare, the out-of-pocket costs associated with your cataract surgery can add up.
A Medigap policy (also called Medicare Supplement Insurance) can help protect you against these costs. If you have Medicare Part A and Part B, you may be eligible to purchase a Medigap plan that fits your unique health care needs.
For example, each type of standardized Medigap plan covers Medicare Part A coinsurance costs.
Learn more about common procedures that medicare covers.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
Compare Medigap plans in your area.Find a plan
Or call now to speak with a licensed insurance agent: