Cataracts, a clouding of the eye’s natural lens, is a condition of aging so common that half of all Americans are affected by age 80. Fortunately, Medicare helps pay for certain medically necessary eye services like cataract surgery. In fact, eighty percent of cataract surgery in the US is performed on Medicare beneficiaries! Here’s what else you need to know about Medicare coverage of cataract surgery.
How much does cataract surgery cost with Medicare?
In general, Medicare Part B (Medical Insurance) covers the costs associated with cataract surgery including the pre-surgery exam where you discuss your cataracts and any post-surgery care as well as ophthalmologist and facility fees. You typically pay the 20% coinsurance amount for the surgery and topical anesthesia, and your Part B deductible applies.
However, it’s difficult to know the exact costs of surgeries or procedures in advance because all necessary services are difficult to predict. If you’re having surgery or a procedure, here are some things you can do in advance to help figure out how much you may have to pay.
- Ask the doctor, hospital, or facility to give you the total costs for surgery and after surgery care.
- Contact your health insurance provider (such as a Medicare Supplement Plan or Medicaid) to see what it will pay.
- Log into MyMedicare.gov or look at your last “Medicare Summary Notice” (MSN) to see if you’ve met your deductibles.
- Check your Part A and Part B deductibles since you’ll need to pay the deductible amounts before Medicare will start to pay. After Medicare starts to pay, you may have copayments for your care.
Does Medicare pay for glasses after cataract surgery?
Although Original Medicare doesn’t cover vision exams – such as if you need everyday prescription glasses – it will cover one pair of eyeglasses or contact lenses after cataract surgery of an implanted intraocular lens (IOL). Not everyone needs glasses after cataract surgery, but if you need post-cataract glasses for reading and other close-up tasks, you pay 20% of the Medicare-approved amount and Medicare Part B will pay for the contact lenses or eyeglasses from a supplier enrolled in Medicare.
Does Medicare cover laser cataract surgery?
In cataract surgery, the cloudy lens inside your eye is removed and replaced with an artificial lens (called an intraocular lens, or IOL) to restore clear vision. The most common cataract surgery procedure, phacoemulsification or “phaco,” uses a high-frequency ultrasound device to break up the cloudy lens into small pieces which are then gently suctioned from the eye. More recently, computer-controlled, high-speed femtosecond lasers — like the lasers used in LASIK surgery— have replaced the hand-held surgical instruments used in phaco. While this newer laser technology may have certain benefits, such as greater accuracy, it may not necessarily be an improvement in safety and visual outcome for everyone. However, whether you and your ophthalmologist select laser-assisted cataract surgery (LACS) or phacoemulsification, Medicare will cover either.
According to the Centers for Medicare & Medicaid Services (CMS), “Medicare coverage and payment for cataract surgery is the same, irrespective of whether the surgery is performed using conventional surgical techniques or a bladeless, computer-controlled laser. Under either method, Medicare will cover and pay for the cataract removal and insertion of a conventional intraocular lens. If the bladeless, computer-controlled laser cataract surgery includes implantation of a PC-IOL or AC-IOL, only charges for those non-covered services specified above may be charged to the beneficiary. These charges may include charges for additional services, such as imaging, necessary to implant a PC-IOL or an AC-IOL but that are not performed when a conventional IOL is implanted. Performance of such additional services by a physician on a limited and non-routine basis in conventional IOL cataract surgery would not disqualify such services as non-covered services. This guidance does not apply to the use of technology for refractive keratopathy.”
Note: The conventional intraocular lens (IOL) covered by Medicare is typically a monofocal lens. Other advanced lens types, such as a toric lens for astigmatism, Lifestyle Lens (multifocal or accommodating lens, or enVista™ lens may have out-of-pocket expenses.
Questions? Let Medicare.org help you navigate the complex world of Medicare. We offer free comparisons for Medicare Advantage (Part C), Medicare Supplement (Medigap), and Medicare Prescription Drug (Part D) Plans. Contact a licensed sales agent at (888) 815-3313 – TTY 711 to help you find the right Medicare coverage for your needs.
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