Does Medicare pay for cataract surgery? Are there restrictions on what they cover? How much will I owe? Is my coverage different with original Medicare and a supplement plan vs. a Medicare Advantage plan? Can I use any doctor or hospital for the surgery? Does Medicare also cover routine eye exams?
Medicare vision coverage
- Medicare covers cataract surgery that is medically necessary
- Your plan pays restorative procedures but not upgrades
- Your out of pocket costs can be anywhere from a few hundred to several thousand dollars
- Benefits are usually much lower with original Medicare and Medigap vs. an Advantage plan
- Any doctor that takes Medicare assignment will accept your Medigap plan
- Doctors that participate in your Advantage plan network will work with you to cover your out of pocket costs
- Is surgery inpatient or outpatient?
Table of Contents
Does Medicare Cover Cataract Surgery?
Medicare does in fact pay for medically necessary surgery to correct vision problems. Original Medicare does not cover routine eye exams or corrective lenses but it does pay for diagnosis and treatment of disease or injury to the eye.
Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B (Medical Insurance) helps pay for corrective lenses (one pair of eyeglasses or one set of contact lenses).
Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).
See Medicare.gov for more information on how Medicare covers corrective lenses.
You can minimize your out of pocket with a good Medicare supplement plan such as F or G. Shop and compare Medigap plans and rates instantly.
How does cataract surgery work?
This video will give you an idea of how modern eye surgery is performed.
How much will I pay for eye surgery?
Your out of pocket cost is determined by how you receive your Medicare benefits, the level of treatment you want, and in some cases, the doctor you choose to perform the procedure.
Original Medicare paired with a Medigap plan will significantly reduce your out of pocket expenses for Medicare approved procedures.
On the other hand, Medicare Advantage plans with their tight networks, moving parts and cost sharing can leave you owing several thousand dollars for Medicare approved surgery.
What is your REAL out of pocket cost for eye surgery?
Medicare will cover the cost of cataract surgery and implant of a standard monofocal IOL (intraoccular lens). With the standard IOL implant your far away vision should be much improved, but many will need glasses for up close work such as reading or hand work.
If you want a high-tech, presbyopia-correcting intraocular lens for your cataract procedure, then costs would increase above the cost of a standard IOL.
Ask your doctor for pricing, any services not covered by Medicare, your expected out of pocket cost and payment plans they may offer.
As indicated above, Medicare will pay for one pair of eyeglasses or contact lenses following implant of a standard IOL. Medicare Part B covers 80% of the approved amount after satisfaction of the deductible. Corrective lenses must be obtained through a Medicare approved provider.
Your out of pocket cost for the surgery will vary by procedure and other factors. Follow this link to an estimate of per eye for cataract surgery and replacement lens.
How can Georgia Medicare Plans help?
Bob Vineyard, president of Georgia Medicare Plans, has worked more than 40 years in the health insurance market and is uniquely qualified to answer all your questions about Medicare.
Did you know there are more than 170 different Medigap plans in Georgia? You can instantly shop and compare rates for around 30 Medicare supplement plans on your own. When you provide a valid email address I will also send you a printout of all the plans in your area, explain the differences in the plans, cover the past rate increase history and help you select a plan that fits your needs and budget.
Which is better for you long term?
A “name brand” carrier with a higher price or one with a lower premium year in and year out that won’t kill your budget? You decide.