Medicare may cover cataract surgery if your doctor determines it is medically necessary, Medicare will most likely cover the operation. However, you may be responsible for paying 20% of the Medicare-approved cost of the procedure.
Medicare and Your Eyes
Cataract surgery is commonly performed in an outpatient setting, which is usually covered by Medicare Part B. If your procedure is approved by your doctor and the Medicare program, Medicare Part B will cover 80% of the surgery cost. You are responsible for paying for the remaining 20% co-insurance.
The exact cost of your cataract surgery will vary depending on the medical services you need. Certain factors can impact your out-of-pocket costs, such as inpatient versus outpatient surgery, other insurance coverage, and annual deductibles. If you are enrolled in a Medicare Supplement insurance policy, the policy will pay for part or all of the remaining 20% Part B co-insurance cost. The coverage amount will vary depending on the policy you buy.
Taking the following steps prior to your cataract surgery can help prevent unexpected costs:
- Ask your doctor and health care facility about the surgery cost and any follow-up care.
- Find out if you will be an inpatient or outpatient for the surgery, because this can impact your out-of-pocket costs.
- Call your insurance provider and ask how much you will pay after Medicare.
- Check your annual Medicare Part A & B deductibles to see if you have to pay additional costs before Medicare pays its part.
Your doctor may recommend additional services or more visits than Medicare approves. You may be responsible for some or all of these additional costs. Please check with your doctor and Medicare to confirm coverage before each medical visit.
Does Medicare cover eye exams for cataracts?
Generally, Medicare does not cover eye exams. However, an eye exam to determine whether or not you have cataracts may be covered. According to an article by Huffington Post, “Medicare will pay for exams to test and treat medical eye diseases and other problems like macular degeneration, dry eye syndrome, eye infections or if you get something in your eye.”
Speak with your eye doctor to find out if your eye exam for cataracts is covered under your Medicare benefits.