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Coverage

Does Medicare Cover Cataract Implants?

Christian Worstell

by Christian Worstell | Published March 30, 2021 | Reviewed by John Krahnert

Original Medicare does not generally cover such routine vision services as glasses and eye exams, but Medicare does cover certain medically necessary procedures, including cataract implant surgery. These services must fall within a specific benefit category and be "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body part."

Medicare Covers Cataract Surgery

Medicare covers surgical procedures that help repair the function of the eye, including the removal of a cataract and replacement of the eye lens with artificial lens implants. Medicare will only pay for glasses or contact lenses if you've had this surgery.

Medicare will also cover the diagnosis of a potentially serious vision problem, even if the result of the diagnosis is that there is no issue.

As for more routine eye care services, Medicare will only pay under certain circumstances:

  • For those with diabetes, Medicare will pay for an eye exam once a year to check for eye disease related to the condition.
  • For those at high risk for glaucoma, Medicare will pay for an eye exam once a year. Those at high risk include people with diabetes, those with a family history of glaucoma, African-Americans aged 50 and older and Hispanics 65 and older.
  • Testing and treatment for those who suffer from age-related macular degeneration.

Medicare Coverage

Original Medicare consists of Medicare Part A and Medicare Part B.

Medicare Part A covers:

  • Hospital care
  • Skilled nursing family care
  • Nursing home care
  • Home health services
  • Hospice care

Medicare Part B covers:

  • Services and supplies needed to diagnose or treat an illness or condition that meet accepted standards of medical practice.
  • Services to prevent or detect an illness or a condition at an early stage.

Medicare Part A and Part B leave behind some out-of-pocket costs that include the following (all dollar amounts are for 2019):

  • Medicare Part A deductible of $1,364 per benefit period for inpatient hospital care
  • Medicare Part A coinsurance for lengthy hospital stays
  • Medicare Part B deductible of $185 per year
  • Medicare Part B coinsurance of 20% of the Medicare-approved amount for doctor services and doctor office visits

Medigap Provides Coverage for Some Costs

Original Medicare covers quite a bit, but the cost of deductibles, copays, coinsurance and other fees can add up quickly. Medigap, also called Medicare Supplement Insurance, can help help fill in these coverage gaps.

There are 10 standardized Medigap plan types that are sold by private insurers in most states (Massachusetts, Minnesota and Wisconsin have other options). Plan availability and cost can vary by state.

Use the chart below to compare the basic benefits of each type of Medigap plan.

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Medicare Supplement Benefits

Part A coinsurance and hospital coverage

Part B coinsurance or copayment

Part A hospice care coinsurance or copayment

First 3 pints of blood

Skilled nursing facility coinsurance

Part A deductible

Part B deductible

Part B excess charges

Foreign travel emergency

A B C* D F1* G1 K2 L3 M N4
50% 75%
50% 75%
50% 75%
50% 75%
50% 75% 50%
80% 80% 80% 80% 80% 80%

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

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1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

2 Plan K has an out-of-pocket yearly limit of $6,220 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

3 Plan L has an out-of-pocket yearly limit of $3,110 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.

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To get answers to all your Medicare questions and learn which Medicare Supplement Insurance options may be right for your specific needs, speak with a licensed agent today. Medicare covers cataract implants, but make sure you have the coverage you need for other health care costs. 

 

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Resource Center

Medicare Preventive Benefits

As a Medicare beneficiary, you may be eligible for a range of preventive health services. Medicare Part B (Medical Insurance) provides coverage for the following. Read more
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