Does Medicare Cover Cataract Surgery?

As you age, your likelihood of developing cataracts increases. About 30% of Americans 65 and older have some kind of vision impairment from cataracts, and for those over 80, that number jumps to 50%. While Medicare does not cover routine vision care such as eye exams for glasses, it does cover diagnosis and treatment for chronic eye conditions, including cataracts. Cataract surgery is considered a medically necessary surgical procedure, but Medicare will only cover the basics.

The Surgerywoman laying down with blue surgical mask over face ad lasers pointing at the eye

Cataracts occur when the lens of your eye becomes clouded. Having this condition makes your vision blurry and less colorful, or like you are looking through a foggy or dusty window. During cataract removal surgery, the surgeon removes the clouded lens and replaces it with an artificial implant. It takes about an hour to perform and can be done in different 2 ways:

  • Phacoemulsification– A tiny probe is inserted into the lens and ultrasound waves are used to break up the cataract. The particles are then “vacuumed” out.
  • Extracapsular– The doctor makes an incision in the cornea and lifts out the lens in one piece before replacing it with the implant. You will most likely need stitches after this procedure.

Surgery is normally very successful for the majority of people who get it done. After surgery, you might need to wear an eye patch and use special eye drops to prevent infection. 

What Medicare Covers

Medicare will cover your cataract surgery as long as it is deemed “medically necessary” by your doctor. Both traditional and laser cataract surgeries are covered, but if you opt for premium products such as intraocular lens (IOL) implants, then you will have significant out-of-pocket expenses that Medicare will not cover. Medicare will also cover one pair of glasses after cataract surgery. 

glasses with words on each lens from a book in the background
Medicare covers one pair of glasses after cataract surgery.

The specific list of what Medicare covers includes:

  • Preoperative exams
  • Removal of cataracts
  • Implantation of lens
  • Postoperative exams
  • One pair of prescription glasses

How Much Medicare Covers

Cataract surgery can cost about $2,700 for one eye and $5,200 for two eyes,  depending on the type of procedure and whether it is done on an outpatient basis or in a hospital. For outpatient procedures, Medicare Part B covers 80% of the costs of the outpatient facility, the doctor’s fees, and other costs related to the surgery, once you meet your deductible. 

Medicare’s Part A will cover the hospital stay if your cataract surgery takes place in the hospital instead of an outpatient facility. You will have to pay a separate Part A deductible if your cataract surgery needs an inpatient stay.

Help with Out-of-Pocket Costsbrown leather wallet with clear screen showing card and money in it

Because Medicare Part B only covers 80% of the cost of the surgery, you will have to pay the remaining 20% out-of-pocket. Having a Medicare Supplement Plan can help you pay this balance. A Medicare Supplement Plan works like any other private insurance plan: you pay monthly premiums and your plan can cover deductibles, copays, and other out-of-pocket expenses. The cost of each plan, as well as the coverage they provide, varies. 

Medicare covers 80% of costs, but if you need surgery or any other type of procedure, you could still end up paying hundred of dollars out-of-pocket. It is wise to have a Medicare Supplement plan to help you pay for those out-of-pocket costs.  In order to find the right Medicare Supplement Plan for you, you’ll have to compare all the different types, which can be time consuming and confusing. EZ.Insure will help compare all the plans and their costs, and will help you sign up for the best plan for your budget. To get free quotes, enter your zip code in the bar above, or to speak directly to a trained agent, call 888-753-7207.

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