Does Medicare Cover Cataract Surgery?
Medicare Part B covers 80% of your cataract surgery cost if it is approved by your doctor and the program. A Medigap policy can help cover the remaining 20%.
Yes, Medicare will cover cataract surgeries. Both Medicare Parts B and C will pay for outpatient procedures that take out cataracts for eligible Medicare beneficiaries.
When Does Medicare Pay for Cataract Surgery?
Medicare provides coverage for outpatient cataract surgery and cataract implants through Medicare Part B, which covers certain diagnostic tests and the costs of surgical centers.
In 2024, the Part B deductible is $240 per year. Once you meet this deductible, you are typically responsible for a 20% coinsurance cost on covered services throughout the rest of the year.
Cataract surgeries are generally performed on an outpatient basis, not requiring hospitalization.
If your cataract surgery requires an inpatient hospital stay, Medicare Part A will cover these costs after you meet a deductible of $1,632 per benefit period in 2024.
How Much Does Cataract Surgery Cost?
The cost may vary depending on the type and location of the procedure, as well as the eye surgeon's fees.
Medicare covers 80% of approved costs when you visit a provider who accepts Medicare assignment. You typically responsible for remaining 20% after you meet your Part B deductible for the year.
According to CMS data, the average cataract surgery costs in the United States were $1,642 in 2023. Of this amount, Medicare paid for $1,313 on average, leaving the patient to pay an average out-of-pocket amount of $328.
The Medicare-approved amount and average costs may change from year to year.
Intraocular Lens (IOL) Coverage
Medicare covers one pair of prescription glasses or one set of contact lenses after a covered cataract surgery.
According to the Centers for Medicare & Medicaid Services (CMS), "Corrective lenses include one pair of eyeglasses with standard frames or one set of contact lenses."
What Do Medicare Supplement Plans Cover?
If you have Original Medicare Parts A and B, a Medicare Supplement plan (also known as Medigap plans) can help cover the deductibles, coinsurance and copayments associated with cataract surgery and other covered medical services.
Medicare Supplement plans are offered by private insurance companies and can help reduce your out-of-pocket costs.
It's important to note that Medicare Supplement plans only work with Original Medicare (Part A & Part B) and cannot be used with Medicare Advantage (Part C) plans.
Out-of-Pocket Costs for Eye Surgery
While Medicare Part B typically covers 80% of the cost of the surgery, you'll be responsible for paying the remaining 20% coinsurance.
To help cover these expenses, some beneficiaries may consider enrolling in a Medicare Supplement Insurance plan that pays for Part B coinsurance, such as Medigap Plan G.
Post-Surgery Care Covered by Medicare
After the procedure for your intraocular lens, you will need follow-up care, including eye exams and the use of eye drops.
Medicare helps cover the associated fees for necessary follow-up care, in addition to any physician fees or hospital costs.
To ensure you are receiving the appropriate coverage for these necessary services, make sure to discuss any concerns with both your healthcare provider and the surgical center.
Qualifying for Eye Surgery
If you're having vision difficulties caused by a cloudy lens, the severity of your eye condition must meet certain requirements before Medicare will cover the cataract surgery.
To determine if you are eligible, consult with your ophthalmologist, who will assess your medical history and current condition.
- Visual acuity: Your visual acuity (sharpness of vision) should be significantly affected by the presence of cataracts.
- Daily activities: Cataracts must interfere with daily tasks such as reading, driving, or watching TV.
- Treatment options: Other treatment options like prescription eyeglasses or contact lenses have proven ineffective in improving your vision.
In addition to these factors, ensure that both your eye doctor and the facility where you'll undergo surgery accept Medicare assignment to avoid unexpected costs.
Does Medicare Cover Cataract Surgery Fully?
Medicare Part B covers 80% of the approved amount for cataract surgery, including lens implants. The remaining 20%, along with any applicable deductibles and copayments, will be the patient's responsibility.
Does Medicare cover the eye exam before cataract surgery?
Yes, Medicare Part B covers diagnostic eye exams for patients with a significant vision problem that requires evaluation or treatment by an ophthalmologist or optometrist.
Medicare doesn't cover routine eye exams, however, unless you have diabetes or are at high risk for glaucoma.
How bad do cataracts have to be to qualify for surgery?
Cataracts must significantly impair your vision and affect daily activities such as reading, driving, or watching TV to qualify for surgery.
Your doctor will assess your visual acuity using a Snellen chart and perform other tests to determine if you're eligible for cataract surgery.
Medicare does cover eye surgery for eligible patients. However, there may be out-of-pocket hospital costs associated with the procedure and post-surgery care.
Learn more about how a Medicare Supplement plan could help pay your out-of-pocket Medicare cataract surgery costs.
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