Key takeaways
- Medicare generally covers cataract surgery with the implantation of a conventional intraocular lens (IOL), which replaces the eye’s natural lens with an artificial one made of acrylic, silicone, or plastic.
- While Medicare does not typically cover the cost of glasses or contacts, Part B will cover one pair of standard frames or a set of contacts after cataract surgery involving IOL implantation. However, the individual is responsible for meeting the Part B deductible and 20% of the Medicare-approved costs.
- The national average cost for cataract surgery varies, with ambulatory surgical centers costing around $1,906 and hospital outpatient departments costing $2,943. However, after meeting the Part B deductible, individuals typically pay approximately $380 or $588, respectively, covering 20% of the costs.
Cataracts are cloudy areas in the lens of the eye and are common as people age. More than half of adults in the United States over the age of 80 have cataracts or have had surgery to correct them, according to the
Surgery is the typical treatment for cataracts when they begin to affect everyday activities, such as driving, reading, or watching television.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance 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.
In most areas, Medicare will generally cover cataract surgery that implants a conventional intraocular lens.
An intraocular lens is a small artificial lens that replaces the natural lens of the eye during cataract surgery. These lenses are typically made of acrylic, silicone, or other plastic compositions.
Medicare only covers basic intraocular lenses. If a healthcare professional recommends a more advanced lens, the individual may be responsible for paying the total cost.
Medicare does not typically cover glasses or contact lenses. However, if a person has cataract surgery that implants an intraocular lens, Medicare Part B will cover one pair of glasses with standard frames or one set of contact lenses.
After an individual meets the Part B deductible of $257, they will be responsible for paying 20% of the Medicare-approved costs. They will also have to pay any additional amounts for upgraded frames.
Medicare will only pay for eyeglasses or contact lenses from a supplier that is enrolled in Medicare.
The total cost of cataract surgery varies by area. However, according to Medicare, the national average cost of cataract surgery is:
- Ambulatory surgical centers: $1,906
- Hospital outpatient department: $2,943
Once a person meets the Medicare Part B deductible, they are responsible for 20% of the Medicare-approved costs.
Based on the national average costs, an individual would pay the following approximate amounts:
- Ambulatory surgical centers: $380
- Hospital outpatient department: $588
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.