Does Anthem Cover Cataract Surgery?

Cataracts are cloudy patches on the tiny lenses in your eyes that can cause blurred vision and blindness. Fortunately, cataract surgery is a relatively safe and straightforward procedure that can correct the visual problems associated with the condition.  

Treating cataracts can significantly improve your quality of life, but many people worry about how to cover the costs. Medicare beneficiaries may be happy to know that Anthem Medicare Advantage plans typically cover cataract surgery. Learn how Anthem covers cataract surgery and how much you may pay out of pocket.

Does Anthem Pay for Cataract Surgery?

All Medicare Advantage (Medicare Part C) plans must cover any services included in Original Medicare (Medicare Parts A and B), including cataract treatment. Therefore, Anthem Medicare Advantage plans usually cover cataract surgery.

Medicare also covers several other cataract care services, such as:

• Cataract diagnosis
• Lens implants
• Corrective lenses and glasses

Generally, you can expect your Anthem plan to cover an intraocular lens implant or cataract correction performed using established surgical or laser techniques. However, it may not cover more advanced lens implants and experimental treatments. 

Original Medicare doesn't cover prescription drugs, so beneficiaries must pay out-of-pocket for any medications required after surgery. However, many Anthem Medicare Advantage plans include prescription drug coverage (Medicare Part D) and cover over-the-counter medications. 

Does Anthem Cover Vision Care?

An Anthem Medicare Advantage plan may cover additional services beyond the scope of Original Medicare if you select a policy with vision coverage.

This coverage may include services, such as routine vision exams, contact lenses and glasses. It may also cover other vision treatments excluded from Medicare Parts A and B, such as LASIK. Benefits can vary from one plan to the next, however, so be sure to consult with your plan documents or check with your plan carrier. 

How Much Is Cataract Surgery?

How much cataract surgery costs depends on several factors, including how much the individual surgeon charges and the treatment method used. Prices can also vary by area. Overall, you can expect to pay between $3,500 and $7,000 per eye for cataract surgery if you don't have healthcare insurance. Enrolling in Original Medicare or a Medicare Advantage plan can significantly reduce the out-of-pocket costs for your treatment. 

Depending on your Anthem plan, it may be more affordable to receive cataract treatment from an in-network healthcare provider. It's essential to make sure your provider accepts Anthem policyholders before scheduling your surgery. 

Is There a Deductible for Cataract Surgery?

Most people will have cataract surgery as an outpatient procedure, which is covered by Medicare Part B. You'll need to pay the Part B deductible if you qualify for coverage through your Anthem Medicare Advantage plan. The Part B deductible for 2024 is $240. 

People covered through Original Medicare must also pay 20% of the approved amount for their cataract surgery, and Medicare covers the remaining 80%. Most Medicare beneficiaries contribute around $579 toward the cost of their treatment. However, Medicare Advantage enrollees may pay less if their plan offers lower deductibles than Original Medicare.