Medicare covers basic cataract surgery, but you may have out-of-pocket costs, including copays. The price may depend on where you get the surgery and other factors.

Cataract surgery is a common eye procedure. It’s generally safe and covered by Medicare. More than 50% of Americans 80 years or older have cataracts or have had cataract surgery.

While Medicare doesn’t cover routine vision screening, it does cover cataract surgery.

You may need to pay additional costs such as hospital or clinic fees, deductibles, and copays.

Some types of Medicare may cover more than others. Different kinds of cataract surgeries also have varying costs.

There are two main kinds of cataract surgery. Medicare covers both surgeries at the same rate. These types include:

  • Phacoemulsification: This type uses ultrasound to break up the cloudy lens. Then, it is removed, and an intraocular lens (IOL) is inserted to replace it.
  • Extracapsular: This type removes the cloudy lens in one piece and inserts an IOL to replace it.

Your eye doctor will determine which type of surgery is best for you.

The average cost of cataract surgery varies from $1906 to $2943 before Medicare pays. But, the cost of these procedures can vary by geographic location and type of facility.

However, these rates will vary by state and the specifics of an individual’s condition and needs.

The exact cost of your cataract surgery will depend on:

  • your Medicare plan
  • type of surgery you need
  • how long your surgery takes
  • where you have the surgery (clinic or hospital)
  • other medical conditions you have
  • potential complications
Cost of cataract surgery with Medicare

An estimated cost of cataract surgery may be:

  • The average total cost of cataract surgery in a surgery center or clinic is $1,906. Medicare pays $1,525, and your cost is $380.
  • The average total cost of cataract surgery in a hospital (outpatient department) is $2,943. Medicare pays $2,355, and your cost is $588.

These estimates include doctor and facility fees. They are national averages and may vary based on location.

Medicare covers basic cataract surgery, including:

  • the removal of the cataract
  • lens implantation
  • one pair of prescription eyeglasses or a set of contact lenses after the procedure

Original Medicare includes Parts A and B.

You may also purchase a Medigap or supplement plan. Each part covers a different kind of healthcare expense. Several parts of your Medicare plan may cover your cataract surgery.

Medicare Part A

Medicare Part A covers inpatient and hospital costs. While hospitalization isn’t usually necessary for cataract surgery, if you get the surgery while admitted to the hospital or need to be admitted to the hospital, it would fall under Part A coverage.

Medicare Part B

Medicare Part B covers outpatient and other medical costs. If you have Original Medicare, Part B will cover your cataract surgery. Part B also covers doctor’s appointments, such as seeing your eye doctor before and after the cataract surgery.

Medicare Part C

Medicare Part C (Advantage Plans) covers the same services as Medicare Parts A and B. However, private companies, rather than the government, provide these plans, and they may have additional costs and coverage.

Medicare Part D

Medicare Part D covers certain prescription medications. If you need prescription medication after your cataract surgery, it may be covered by Medicare Part D. If your medication isn’t on the approved list, you may have to pay out of pocket.

Part B may also cover some medications related to your surgery if they’re considered medical costs. For example, if you need to use certain eye drops only before your surgery, Part B may cover them.

Medicare supplement plans (Medigap)

Medicare supplement plans (Medigap) cover some costs that Original Medicare does not, such as deductibles and copays for Original Medicare. If you have a Medigap plan, you can ask a healthcare professional which expenses it covers.

You’ll need information from your eye doctor and your Medicare provider to determine what you may need to pay out-of-pocket for your cataract surgery.

Questions to ask your doctor

You can ask your doctor or insurance provider the following questions to help determine your out-of-pocket costs for cataract surgery:

  • Do you accept Medicare?
  • Will the procedure be performed at a surgical center or at a hospital?
  • Will I be an inpatient or an outpatient for this surgery?
  • What prescription medications will I need before and after cataract surgery?
  • What is the Medicare code or specific name of the procedure you plan to perform? (You can use this code or name to look up costs on Medicare’s procedure price lookup tool.)

Your doctor may be able to tell you what percentage of your surgery is covered and what you will owe out of pocket.

If you have a Medicare Advantage plan or another plan through a private insurance provider, your provider can tell you your expected out-of-pocket costs.

Your Medicare coverage and the plans you choose will determine the exact amount you will pay out-of-pocket. Other coverage factors that will affect your out-of-pocket costs include:

  • your Medicare plans
  • your deductibles
  • your out-of-pocket limits
  • if you have other health insurance
  • if you have Medicaid
  • if Medicare Part D covers the medications you’ll need
  • if you have other medical conditions that make the procedure more complex

If you are a veteran, your VA benefits may be more affordable for cataract surgery.

A cataract forms when the clear lens of your eye becomes stiff or cloudy. Symptoms of cataracts include:

  • cloudy vision
  • blurred or dim vision
  • faded or yellowed colors
  • double vision
  • difficulty seeing at night
  • seeing halos around lights
  • sensitivity to bright light and glare
  • changes in vision

Cataract surgery removes and replaces the clouded lens with a surgically implanted lens. An ophthalmologist (eye surgeon) typically performs this type of surgery as an outpatient procedure. This means that you won’t need to stay in the hospital overnight.

Is cataract surgery covered 100% by Medicare?

While Medicare covers cataract surgery, you will likely have to pay out-of-pocket for some of the costs, including copays and doctors’ fees. Your costs can depend on your location and the type of facility that performs your surgery. Medicare estimates that you will pay around $380 to have the surgery at a surgical center and $588 to have the surgery at a hospital outpatient department.

Does Medicare provide free glasses after cataract surgery?

Medicare Part B typically covers corrective lenses, such as one pair of glasses or one set of contacts, after cataract surgery to implant an intraocular lens.

How bad do cataracts have to be before insurance will pay?

Medicare and many other insurance providers cover medically necessary cataract surgery, such as if your best correct visual acuity is 20/40 or worse or glare testing reduces your vision. The insurance companies may also cover surgery if daily activities are difficult due to your cataracts.

Cataract surgery is a common procedure covered by Medicare. However, Medicare doesn’t pay all of the costs, and you may still have some out-of-pocket costs even if you have Medigap.

These costs can include deductibles, co-payments, coinsurance, and premium fees. There may also be additional costs if you need more advanced cataract surgery or have health complications.

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