Medicare does not usually cover vision care but it may cover some cataract surgeries if they are medically necessary and the doctor performing the surgery accepts Medicare for payment.
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Typically, Medicare Part B (outpatient medical insurance) pays 80% of the expenses related to cataract surgery. This includes one pair of glasses following the surgery.
If cataract surgery requires a hospital stay, Medicare Part A (hospitalization insurance) will cover it. Medicare Advantage plans, also called Medicare Part C, bundle the offerings of parts A and B.
This article explains the costs of cataract surgery and which expenses Medicare will and will not cover.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Different parts of Medicare cover different aspects of cataract surgery.
Medicare Part B
Since surgeons generally perform cataract surgery on an outpatient basis, it falls under Medicare Part B. This covers certain postsurgical costs. Usually, Medicare pays 80% of the total surgical cost for the procedure itself and the facility charges.
Part B covers the following services:
The monthly premium for Part B in 2024 is $174.70. The annual deductible is $240 in 2024.
Medicare Part A
Medicare Part A covers inpatient hospital stays. People do not usually require an overnight stay after cataract surgery. However, if a hospital stay is necessary due to significant complications, Part A will cover the extra accommodation costs.
If admitted to the hospital, a person would need to pay the Medicare Part A deductible of $1,632 in 2024.
Medicare Part C
Medicare Advantage (Part C) plans are an alternative to Original Medicare (parts A and B). Because of this, they need to provide at least the same coverage for everything, including cataract surgery.
Medicare Part D
Medicare Part D is a prescription drug plan available to people who have Medicare Part A and Part B. If a person with a Part D plan needs a prescription drug to take at home following cataract surgery, their plan will likely cover part of the cost.
Medigap
Medicare supplement plans, also known as Medigap plans, are private insurance policies that help people pay the 20% of costs excluded from Medicare coverage. These plans may pay deductibles, copayments, and other out-of-pocket expenses.
Any person with Original Medicare can apply for a supplement plan. Costs vary. A person with a Medicare Advantage plan is not eligible to buy a Medigap plan.
Although Medicare usually covers cataract surgery that a doctor deems medically necessary, the requirements for coverage vary between regions. Before undergoing the procedure, a person may wish to check the regulations of their local Medicare carrier.
Medicare Part B does not cover the remaining 20% of the cost of cataract surgery. Plans may also exclude certain other charges, including deductibles and medications such as eye drops.
An individual’s share of the cost of cataract surgery depends on the type of operation they have.
Laser surgery
Medicare pays the same amount toward cataract surgery whether a surgeon conducts it with or without a laser. However, laser surgery has a higher cost and is used for those with astigmatism who need a premium lens implant.
The surgical center will ask the individual to pay the difference between the covered amount and the additional costs of laser surgery.
Learn more about laser eye surgery.
Lenses
During cataract surgery, a surgeon inserts an intraocular lens (IOL). Medicare may not cover all types of IOLs. However, it does pay for monofocal lenses.
Although other lenses, including multifocal and toric lenses, are available, Medicare may not cover these. It also does not pay for procedures relating to the implantation of these more advanced lenses if a surgeon would not perform them for a traditional monofocal lens.
Lifestyle factors and daily activities determine the best type of lens for a person receiving cataract surgery. They will need to discuss this with their eye surgeon and remain aware of the extra costs associated with more advanced lenses.
Learn how long it takes to recover from cataract surgery.
Medicare indicates the average cost of cataract surgery ranges between $1,906 and $2,943 per eye, depending on the type of care facility that performs the procedure.
Costs can also vary depending on:
- the type of procedure
- the surgeon’s fees
- the type of lens implant
It is best to discuss the overall charges with the surgeon for the most accurate picture of the total cost.
Questions to ask about cost
To determine potential out-of-pocket costs, a person should ask the following questions before their surgery:
- Does the doctor accept Medicare?
- Will the surgery take place in a hospital or at a surgical center?
- Will the procedure take place on an inpatient or outpatient basis?
- Which medications are the doctor likely to prescribe before and after surgery?
- What type of lens will the surgeon implant?
It is also good practice to ask for the Medicare code for the procedure. This can help a person more accurately determine coverage through Medicare’s online tool.
Read more about the cost of cataract surgery.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare pays money toward cataract surgery as long as a doctor agrees that it is medically necessary.
The cost of cataract surgery may vary. Medicare Part B usually covers 80% of the surgical costs. People may wish to use Medicare supplement plans, such as Medigap, to help cover the remaining 20%.
Several factors can affect the cost of cataract surgery, such as the surgery setting, the surgeon’s fees, and the type of lens the surgeon implants.
For information about paying for cataract surgery, people can speak directly with their insurance provider.