Does Blue Cross Blue Shield Cover Cataract Surgery?

In this article...
  • Blue Cross Blue Shield Medicare Advantage (Part C) plans cover cataract surgery, as it’s covered by Original Medicare (Parts A and B). Learn about the other vision benefits some BCBS Medicare plans may offer, how much cataract surgery costs with Medicare and more.

Cataract surgery can cost between $3,500 and $7,000 per eye, which should beg the question of whether it’s covered by insurance.

Blue Cross Blue Shield (BCBS) Medicare Advantage plans typically cover cataract surgery when it’s considered to be medically necessary treatment. Medicare Advantage (Medicare Part C) plans are required to cover the same benefits that are covered by Original Medicare (Part A and Part B).

Because cataract surgery is covered by Original Medicare when performed using traditional surgical methods or with the use of lasers, all Medicare Advantage plans, like the ones from Blue Cross Blue Shield, at least cover the same type of surgery. Some plans may cover even more routine vision care costs than Original Medicare, such as prescription glasses, contacts, eye exams and more.

Blue Cross Blue Shield affiliate companies can vary by state, so it’s best to compare plans online or call to speak with a licensed insurance agent to find the specific plan benefits available where you live.

When Do Blue Cross Blue Shield Medicare Plans Pay for Cataract Surgery?

While benefits may differ from one plan to another, Blue Cross Blue Shield Medicare Advantage plans will generally cover cataract surgery that implants a monofocal intraocular lens. If a more advanced lens is used for the implant, it may or may not be covered. 

It’s common for a patient to be prescribed a pair of eyeglasses following cataract surgery, or for a previous prescription to be modified after the procedure. A Blue Cross Blue Shield Medicare that includes BCBS Medicare vision coverage will typically help pay for some of the following:

  • Routine vision exams
  • Frames
  • Eyeglass lenses
  • Contact lenses
  • Sunglasses and non-prescription glasses
  • LASIK surgery may
  • Retinal imaging

How Much Does Cataract Surgery Cost With Medicare?

When Medicare Part B pays for cataract surgery, the Part B annual deductible will apply and the beneficiary will typically be responsible for a 20% coinsurance of the Medicare-approved amount after they meet their deductible.

A Medicare beneficiary who only has Part B could pay an average of $565 out of pocket for cataract surgery. Some Medicare Advantage plans may have lower deductibles, or they may cover cataract surgery with lower copay or coinsurance amounts than Original Medicare.

Depending on your Blue Cross Blue Shield Medicare Advantage plan, you may need to have the surgery performed by an in-network doctor to maximize your coverage. Before signing up for a BCBS Medicare plan, you can confirm with a licensed insurance agent or online that your doctor accepts the Blue Cross Blue Shield plan.

Most Medicare Advantage plans include vision benefits which may cover any prescription lenses that result from the surgery. And if any prescription medications are needed post- or pre-surgery, most Medicare Advantage plans include drug benefits as well. 

How to Know if You Are a Candidate for Cataract Surgery

Symptoms of cataracts are cloudy or blurry vision, experiencing glares or “halos,” exceptionally poor night vision, faded colors and increased nearsightedness. 

Cataracts are usually diagnosed with a visual acuity test or by dilating the pupils and conducting a thorough examination of the retina. 

In the early stages of cataracts, you may be able to adjust your eyeglass prescription or use different lighting in your home. But once your cataracts progress to the point where they are interfering with your activities of daily living, surgery is generally the only option. 

Cataract surgery is most often performed by making a small incision around the edge of the cornea, using ultrasound waves to break up the cataract and then removing it with suction. Then a new artificial lens is placed into the eye. 

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