Does Medicare Cover Cataract Surgery?

Thereare two main kinds of cataract surgery. Medicare covers both surgeries at thesame rate. These types include:

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

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

According to the American Academy of Ophthalmology (AAO) in 2014, the general cost of cataract surgery in one eye with no insurance was approximately $2,500 for the surgeon’s fee, the outpatient surgery center fee, the anesthesiologist’s fee, the implant lens, and 3 months of postoperative care.

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*:

• In a surgery center or clinic, the average total cost is $977. Medicare pays $781, and your cost is $195.
• In a hospital (outpatient department), the average total cost is $1,917. Medicare pays $1,533 and your cost is $383.

*According to Medicare.gov, these fees don’t include physician fees or other procedures that may be necessary. 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 is divided into four main parts: A, B, C, and D. You may also purchase a Medigap, or supplement, plan. Each part covers a different kind of healthcare expense. Your cataract surgery may be covered by several parts of your Medicare plan.

Medicare Part A

Medicare Part A covers inpatient and hospital costs. While in most cases there’s no hospital necessary for cataract surgery, if you need to be admitted to the hospital, this would fall under Part A coverage.

Medicare Part B

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

Medicare Part C

Medicare Part C (Advantage Plans) cover the same services as Original Medicare parts A and B. Depending on the Advantage Plan you choose, all or part of your cataract surgery will be covered.

Medicare Part D

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.

Some medications related to your surgery may also be covered by Part B if they’re considered medical costs. For example, if you need to use certain eye drops only before your surgery, they could be covered by Part B.

Medicare supplement plans (Medigap)

Medicare supplement plans (Medigap) cover some costs that Original Medicare does not. If you have a Medigap plan, call your healthcare provider to find out which expenses it covers. Some Medigap plans cover deductibles and co-pays for Medicare parts A and B.

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

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

The exact amount you will pay out-of-pocket will be determined by your Medicare coverage and the plans you choose. Other coverage factors that will determine 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 the clouded lens and a new lens is surgically implanted. This surgery is done by an eye surgeon, or ophthalmologist. Cataract surgery is typically an outpatient procedure. This means that you won’t need to stay in the hospital overnight.

Cataract surgery is a common procedure that’s covered by Medicare. However, Medicare doesn’t pay everything and Medigap may not make it completely cost-free either.

You may have to pay deductibles, co-payments, co-insurance, and premium fees. You may also be responsible for other costs if you need more advanced cataract surgery or have health complications.

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