On average, a person may spend between $1,808 and $2,866 per eye for cataract surgery. However, the actual cost can vary based on who performs the surgery, the location of the hospital where the surgery takes place, health insurance, and other available options.
The above figures come from Medicare.
Cataracts are cloudy areas in the lens of the eye, the transparent, encapsulated structure that sits behind the pupil and helps focus light onto the retina.
This article takes a look at average cataract surgery costs, Medicare coverage, and why it can be important to ask for detailed estimates.
Average cataract surgery costs vary depending on the source.
Medicare, which bases national averages on 2022 payments, indicates the average cost ranges between $1,808 and $2,866 per eye, depending on which type of care facility performs the procedure.
Similar numbers were noted in a 2019 report published in the journal Clinical Research in Ophthalmology that found the average cost of cataract surgery as of 2018 was $2,526 per eye.
However, it is important to note that the average cost is not always as straightforward as it seems. Many of these numbers are for the cost of surgery and the facility only. Cataract surgery can, and often does, involve more than just these two fees.
In the 2019 report, authors include a breakdown of surgical fees that lists the following:
initial comprehensive exam
intraocular lens (IOL) implant
These are all things that are usually necessary parts of the cataract surgery process. With these inclusions, total costs went up to $4,131 for one eye and $8,026 for both eyes.
For this reason, receiving an itemized estimate before cataract surgery can help ensure a correct understanding of total costs.
As of 2022, people who do not have insurance or do not plan on submitting an insurance claim are entitled to a “good faith estimate” from healthcare professionals or healthcare facilities that shows costs related to a service.
Cataract surgery is considered a necessary procedure to restore vision. Most major insurance companies cover the surgery, but policies vary by company.
Copay requirements, percentage of coverage, and preapproval polices can all depend on what selections an individual or family has made during the initial sign-up process.
Medicare does cover 80% of allowable charges for cataract surgery, regardless of how it is performed. This can include conventional methods or newer laser-assisted cataract surgery.
It is important that a person understands what services they will receive and what services Medicare allows and covers to best understand any out-of-pocket costs they may be responsible for. Talking with their eye care team regarding costs associated with their surgery is a helpful first step.
Facilities and physicians can charge people only for the noncovered portion of medical services provided at the same time as a covered service.
This means that Medicare beneficiaries need to be prepared to pay the 20% copay Medicare Part B requires plus any additional costs the surgeon may charge for advanced surgical technology and premium IOLs.
The procedure must be declared a medical necessity under Medicare policy, which means it meets one or more of the following criteria:
cataract is causing symptomatic impairment of visual function that is not correctable by non-operative means
the cataract prevents the monitoring or treatment of another intraocular disease, like diabetic retinopathy
the lens is a part of progressive disease threatening vision or ocular health, such as phacolytic glaucoma
there is a risk of accelerating cataract development from subsequent procedures or treatments
cataract interferes with vitreoretinal surgery
the presence of vision distortions that are uncorrectable with nonsurgical options after single-eye lens extraction
What can a person expect to pay out of pocket?
Medicare lists two average out-of-pocket expenses for cataract surgery, depending on where the surgery takes place:
Ambulatory surgical centers: A person can expect to pay $361. An ambulatory surgical center is a non-hospital facility. People do not require more than 24 hours of care.
Hospital outpatient departments: A person can expect to pay $573. This is a part of the hospital where people can get outpatient services, including an observation unit, pain clinic, or surgery center.
Surgery cost break down with Medicare
Cost of cataract surgery, as listed under Medicare national averages, breaks down into two groups.
This does not mean Medicare will only cover $1,445 or $2,292. Medicare coverage is based on a percentage and is calculated after a yearly deductible is met.
Outpatient services, such as cataract surgery, are covered under Medicare Part B.
Once the 2023 yearly deductible is met, Medicare will pay 80% of the Medicare-approved amount, a preset cost cap. The Centers for Medicare & Medicaid Services notes that the yearly deductible for services Medicare Part B covers is $226.
Medicare-approved amounts may be less than what a provider charges, which means the patient cost increases.
A Medicare representative or the cataract surgical provider can offer insight into what the Medicare-approved amount is.
Questions to ask insurance providers
Asking an insurance provider the following questions can help ensure costs are clearly defined.
Under what criteria is cataract surgery covered?
Are presurgical and postsurgical care included?
What is the percentage of coverage?
What is the necessary deductible?
Are there medications, procedures, or items not included in coverage?
What out-of-pocket expenses can be expected?
Are all types of IOL replacements covered?
Does the surgery have to be performed by a specific doctor or care facility?
Will insurance cover laser surgery or only traditional surgery?
Is a second opinion required?
Does coverage change if more procedures are required?
Without insurance, cataract surgery can cost approximately $4,131 per eye.
Medicaid is a federal and state initiative that more closely mimics private insurance options. It is available for people with limited resources and income.
Medicaid plans are set by the state and come with many options, similar to non-government insurances. Cataract surgery may be covered under some Medicaid vision plans.
A person can find Medicaid programs, their coverage, eligibility criteria, and further resources by visiting the State Profiles page at Medicaid.gov.
Many factors can affect cataract surgery cost, including:
type of procedure
type of IOL used
use of technology, like laser assistance
medications administered on day of procedure
add-on of other eye correction services
adverse events/postsurgical complications
Even with insurance, cataract surgery cost may be very expensive.
A person can find financial assistance options and for vision care, as well as eligibility guidelines, at the following:
The National Eye Institute The American Academy of Ophthalmology EyeCare America Program
The HealthWell Foundation
The Hill-Burton Program
Mission Cataract USA
Some care facilities also offer their own payment plans that can help lower upfront costs by spreading them over a longer period of time.
The average cost for cataract surgery can range between $1,808 and $2,866 per eye.
Costs may be higher based on individual needs, type of surgery performed, and which IOLs are used.
Medicare does cover costs for cataract surgery, but the Medicare beneficiary will also incur out-of-pocket costs. The eye care team should be able to provide a reasonable estimate of these costs and how they are handled. Other private health insurance and Medicaid coverage will vary by state and personal plan selection.