Cataracts – a less than ideal part of aging. More than half of Americans over the age of 80 have cataracts or have had corrective surgery to fix them. If left untreated, cataracts can interfere with daily life and in some cases even lead to blindness. But the good news is that, for the most part, cataract surgery is painless, simple, and safe.
Although it sounds great, it’s hard not to think about the costs. Will Medicare pay for cataract surgery? The short answer is yes. Original Medicare often does not cover routine eye care services, but cataracts are covered if the procedure is deemed medically necessary.
Let’s take a moment to talk about which parts of Medicare will cover cataract surgery, what types of procedures are covered, and what that means for overall out-of-pocket costs.
Parts of Medicare that cover cataract surgery
Different parts of Medicare offer coverage for cataract surgery, but it all depends on what plan you have. Typically, cataract surgery is performed on an outpatient basis where Original Medicare (Part B) or Medicare Advantage (Part C) comes into play. Here’s what you need to know.
Medicare Part B covers cataract surgery
For people on Original Medicare whose cataract surgery is deemed medically necessary by their doctor, Part B will cover the cost of the procedure – but you’ll still have some out-of-pocket costs. You can expect Medicare to cover about 80% of the total cost of surgery once the deductible is reached. This means that you are responsible for the remaining 20%.
Medicare Part C (Medicare Advantage) coverage for cataract surgery
Medicare Advantage plans, offered by private companies, work as an alternative to Original Medicare.
Medicare Advantage out-of-pocket costs depend on the type of coverage you have, but you won’t pay more than 20% of what you would pay with Original Medicare. It should also be noted that with a Medicare Advantage plan, finding an eye doctor in your network will help keep costs down.
Medicare cost plans are another type of private Medicare plan that can help pay for cataract surgery. As with Medicare Advantage plans, if you have a cost plan, you won’t pay more than 20% co-insurance for cataract surgery.
Certain areas of cataract surgery that are covered by Medicare
The great news is that coverage is not just limited to the actual procedure. It covers almost all aspects of care related to cataract surgery. Medicare will cover part of the initial eye exam, any additional pre-surgery tests, medications, facility and provider services, up to a year of follow-up care and beyond.
Does Medicare cover glasses after cataract surgery?
While Medicare Part B usually doesn’t cover glasses or contacts, cataract surgery is an exception. If you need additional repair supplies after surgery, Original Medicare and Medicare Advantage will cover the cost of one set of Medicare-approved glasses or contact lenses.
Some Medicare Advantage plans also offer enrollees a prepaid benefit card or glasses allowance that can be used for additional pairs of glasses or contact lenses. Depending on what vision benefits your Medicare Advantage plan offers, you may also have coverage for future eye exams and checkups.
What type of lenses does Medicare cover for cataract surgery?
Original Medicare and Medicare Advantage include a standard intraocular lens (IOL). This small disc replaces the natural lens that has been blurred or clouded by cataracts. It can be implanted using basic surgical techniques or lasers.
Does Medicare cover YAG laser capsulotomy?
YAG laser capsulotomy is an outpatient procedure that some people require months or even years after cataract surgery. If your vision becomes foggy again (sometimes referred to as a “secondary cataract”), this follow-up surgery may help restore it.
If your doctor deems it medically necessary, Original Medicare, Medicare Advantage, or a cost plan will help cover the cost of a YAG laser capsulotomy—this includes all necessary tests, medications, and a year of follow-up care.
Cost of cataract surgery with Medicare
The average estimated cost of cataract surgery without insurance varies – one eye probably costs between $3,000 and $7,000. This is quite a significant range of costs, because some of the procedures are performed in outpatient surgical centers and some in outpatient clinics.
According to Medicare.gov, for the average extracapsular removal in 2022 (after Medicare contribution), you can expect to pay approximately $361 for surgery performed at an outpatient surgical center or $573 for surgery performed at a hospital outpatient clinic. However, please note that these are estimates – additional fees may apply and the total cost may change over time. Be sure to contact your Medicare plan representative if you have any questions so you can get a good idea of how much you will have to pay.