In general, Medicare covers cataract surgery but there are some restrictions. Original Medicare, Medigap, and Medicare Advantage plans all include coverage for cataract surgery. However, the level of coverage and your out-of-pocket costs will depend on the type of Medicare plan you have.

Original Medicare and Medigap plans do not include coverage for medications required before or after the surgery. However, Medicare Advantage plans will typically include prescription drug coverage and routine eye exams.

Original Medicare and cataract surgery coverage

Original Medicare includes hospital insurance (Part A) and medical insurance (Part B). Cataract surgery will be covered under your Medicare Part B benefits.

Under Original Medicare, you will be covered for:

• Pre-surgery eye exams
• Standard cataract surgery including anesthesia
• Laser cataract surgery
• Corrective glasses, lens implants, or contacts lenses related to your cataract care
• Follow-up care

It is important to note that under your Original Medicare Plan routine eye exams are not covered. You will also be required to pay coinsurance costs of up to 20% and Medicare Part B deductibles. Medicare Part B will not cover any medications that may be required after your cataract surgery.

How can Medicare Supplement (Medigap) help with cataract surgery bills?

A Medicare supplement policy or Medigap is an add-on to Original Medicare that can be purchased from private insurers. A Medigap plan will help to cover some of your out-of-pocket costs or copayments for the cataract surgery that Original Medicare does not cover.

With Medigap, your Medicare Part B is billed first for 80% of the cost of the cataract surgery then the supplemental plan is billed reducing your copayment further. If you have a Medigap plan, your copayments for cataract surgery will range from $0 to 10%.

Most Medigap plans will cover the total cost of the Medicare Part B copayment meaning you will not need to pay anything for your cataract surgery or post-surgery care.

What does Medicare Advantage cover for cataract surgery?

Medicare Advantage plans or Medicare Part C are offered by private insurance companies and include Medicare Part A and B as well as additional benefits. Medicare Advantage plans will cover the cost of cataract surgery and follow-up care but the coverage level will depend on the limits set on your plan.

Your Medicare Advantage plan will often cover:

• Presurgical appointments
• The cataract surgery, including anesthesia
• Corrective glasses, implants, or contacts lenses
• Follow up care
• Prescription drugs (depending on your plan)

Most Medicare Advantage plans include prescription drug coverage, but this can vary depending on your particular plan. Check with your provider to see if medications for cataract surgery will be covered under your plan.

Unlike Original Medicare, many Medicare Advantage plans include vision coverage. This means that apart from cataract surgery, your plan may also cover routine eye exams and nonsurgical eye treatments.

Medicare Part D and cataract surgery

Medicare Part D covers the cost of prescription drugs. If you need medications before or after your cataract surgery, Medicare Part D will cover the costs. Some of the medications covered include antibiotic eye drops, steroids, or other related prescriptions.

Medicare requirements for cataract surgery

Medicare will cover the cost of your cataract surgery if you meet the following criteria:

• You are 65 or older
• Cataract surgery has been deemed medically necessary by your doctor
• Your doctor or ophthalmologist accepts Medicare

How much does cataract surgery cost with Medicare?

The cost of cataract surgery depends on the type of surgery you get, your location, and the type of Medicare plan that you have. On average out of pocket costs for such surgery with Medicare can range from $200 to $700.

Depending on your Medicare plan, you can expect to incur the following costs:

• If you have Original Medicare, you will pay 20% of the total cost of your cataract surgery
• If you have a Medigap plan to supplement your Original Medicare, you will pay up to 10% of the total cost of the surgery in copayments, but depending on your plan, all your copayments may be covered.
• If you have a Medicare Advantage Plan, you will incur copayments for your cataract surgery, but the percentage can vary greatly.

How much does Medicare pay for glasses after cataract surgery?

After your cataract surgery, your Medicare plan will also cover one pair of eyeglasses with standard frames or a set of contact lenses. However, deluxe frames, progressive lenses, or tinting are not covered. Copayments may apply depending on the type of Medicare Plan that you have.

Medicare cataract surgery exclusions

Whether you have Original Medicare, Medigap, or a Medicare Advantage plan, cataract surgery will be covered. However, there are some exclusions to the coverage depending on the type of plan you have.

Original Medicare only covers 80% of the total cost of cataract surgery. It also excludes coverage for prescription drugs, copayments, and deductibles.

Also, depending on your Medicare plan, Medicare may not cover all types of intraocular lenses (IOL). Multifocal and toric lenses may not be included in your coverage.

Frequently Asked Questions

Does Medicare cover routine eye exams?

Original Medicare does not include coverage for routine eye exams. However, you will be covered for cataract surgery and prescription lenses or contact lenses after the surgery under your Medicare Part B, Medicare Supplement plan, and Medicare Advantage.

Which Medicare Plan is best for cataract surgery?

Medicare Advantage plans may offer the best coverage for cataract surgery since they typically include coverage for surgery, corrective lenses, prescription drugs and follow-up care. Original Medicare and Medigap plans will not cover you for medications needed before or after the surgery.

Does Medicare cover laser cataract surgery?

Medicare plans cover both traditional and laser cataract surgery. However, laser surgery typically costs more so your copayments or out-of-pocket costs will be higher.

Will Medicare cover follow-up care after cataract surgery?

Yes, Medicare plans include coverage for follow-up care after cataract surgery. Both Medicare Part B and Medicare Advantage plans will cover it.