Medicare covers cataract surgery, an advanced treatment option for cataracts, if your doctor says it is medically necessary. But you may be responsible for paying 20% of the Medicare-approved cost of the procedure.
A cataract is a clouding of the lens of the eye that can impair vision, according to the National Eye Institute (NEI). The condition develops slowly, but it can cause multiple issues such as clouded vision, nearsightedness, night driving problems, daytime glare, and double vision. Cataracts can develop in one or both eyes.
The condition is very common for senior citizens. More than 90% of people over the age of 65 have a cataract, according to the University of Michigan Kellogg Eye Center.
Although cataracts typically develop due to aging, the NEI lists 4 additional types of cataracts including:
- Secondary cataracts: Cataracts that develop after negative medical conditions or exposure to harmful substances
- Traumatic cataracts: Cataracts that develop after an eye injury
- Congenital cataracts: Cataracts that develop before birth or during early childhood
- Radiation cataract: Cataracts that develop after radiation exposure
Cataract treatment options
If you have a minor case of cataracts, eyeglasses or contact lenses can moderately correct the diminished vision. If this treatment is recommended, you may have to pay for the costs yourself since the Medicare program provides limited vision coverage.
If your case is more serious, your doctor may recommend cataract surgery. The NEI states that cataract surgery is the only effective treatment for cataract-related vision loss.
Cataract surgery is a procedure which removes the clouded lens of the eye and replaces it with an artificial lens (intraocular lens). An ophthalmologist, a doctor who specializes in eye and vision care, will usually perform the surgery.
Most patients receive an artificial lens, but some cannot have the implant, according to the NEI. These patients may need to wear soft contact lenses or high magnification glasses after surgery.
Medicare and Medicare Supplement insurance coverage
Cataract surgery is commonly performed in an outpatient setting, which is usually covered by Medicare Part B. Medicare.gov states that 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.
Medicare.gov recommends several steps before undergoing cataract surgery to 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.