Does Medicare Cover Cataract Surgery?
- Medicare covers cataract surgery, both phacoemulsification and extracapsular. Learn how much cataract surgery costs with Medicare and what you should know before the procedure.
Many Medicare beneficiaries are aware that Original Medicare (Medicare Part A and Part B) does not cover routine vision care. But what about cataract surgery?
Medicare does indeed cover the cost of cataract surgery, and there is plenty for beneficiaries to know about the coverage.
When Does Medicare Pay for Cataract Surgery?
Medicare Part B and all Medicare Advantage (Part C) plans cover preoperative and postoperative eye exams, the removal of the cataract, the insertion of basic lens implants and one set of prescription eyeglasses or one set of contact lenses following the procedure.
Hospitalization is typically not needed for cataract surgery. But should hospitalization occur as a result of any complications, your hospital stay will be covered by Medicare Part A and all Medicare Advantage plans.
There are two main types of cataract surgery, phacoemulsification and extracapsular. Medicare provides coverage for both.
How Much Does Cataract Surgery Cost With Medicare?
You pay 20% of the Medicare-approved amount for cataract surgery after you meet the annual Part B deductible, which is $203 in 2021. This 20% cost is your Part B copay.
According to Medicare.gov, the official government website for Medicare, Medicare Part B beneficiaries pay an average coinsurance of $357 per eye when the procedure is performed at an ambulatory surgical center and $565 per eye when performed in a hospital outpatient department. Costs include both a facility fee and a doctor fee.
You then must also pay 20% of the Medicare-approved amount for the eyeglasses or contact lenses following the surgery.
If the surgery is performed by a doctor who is enrolled in Medicare but does not accept Medicare assignment, you may be charged up to 15% more for the procedure.
Beneficiaries with a Medicare Supplement Insurance (also called Medigap) plan can have the 20% coinsurance covered in full. Some Medigap beneficiaries may even have the Part B deductible covered as well.
Millions of Medicare beneficiaries rely on Medicare Supplement plans to help protect them from potentially high medical costs, especially when they need to have surgery. You can learn more about Medigap plans and find plans available where you live by comparing plans online or calling to speak with a licensed insurance agent.
What Should Beneficiaries Know About Medicare and Cataract Surgery?
There are a few things beneficiaries should know about Medicare’s coverage of cataract surgery.
- In order for Medicare to cover the cost of cataract surgery, a doctor must determine the procedure to be medically necessary.
- The surgery must be performed at a Medicare-approved facility by a Medicare-participating doctor or a doctor who accepts Medicare assignment, and the supplier of your eyeglasses or contact lenses must also be enrolled in Medicare.
- Medicare will only pay for a basic set of intraocular lenses and eyeglasses with basic frames. More advanced intraocular lenses or frames may require you to pay some or all of the cost.
- After cataract surgery, you will usually be prescribed eye drops or an antibiotic, which may be covered by a Medicare Part D plan or Medicare Advantage plan that includes prescription drug coverage. These medications will not be covered by Original Medicare.
- The cost of a cataract surgery performed with a laser is generally more expensive than when a laser is not used.
Where Can I Ask Questions About Cataract Surgery and Medicare?
If you’re enrolled in Original Medicare, you may call Medicare at 1-800-MEDICARE (1-800-633-4227) for questions about coverage of cataract surgery.
You can also compare Medicare Supplement plans online to find out if a plan is available near you that can help cover the out-of-pocket Medicare costs of cataract surgery.