Does Medicare Cover Cataract Surgery?
- Does Medicare cover cataract surgery? Find out what types of procedures are and aren't covered by Medicare so you can make informed decisions about your care.
Does Medicare cover cataract surgery? Traditional Medicare doesn’t cover vision care, but this is an exception to Medicare Part B. Since Medicare Advantage plans are required to cover the same procedures covered under traditional Medicare, you can receive coverage under an Advantage plan as well. Your costs may vary greatly depending on whether you are using Medicare Part B or an Advantage plan, however, because Advantage plans are offered by private insurers.
If you’re covered under Medicare Part B, the coverage includes the cost of one pair of glasses following your surgery as well. There are some types of procedures and treatments that your doctor might recommend that do not qualify for Medicare coverage, so you will need to make sure that the procedure you are considering is covered. If it isn’t, you may be required to pay the entire cost.
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What Type of Cataract Surgery Does Medicare Cover?
What Medicare typically covers are procedures that remove the cataract and install a corneal lens implant to assist with your vision. Any ongoing vision care following your surgery is not covered unless you’re enrolled in a Medicare Advantage plan that offers vision coverage. Since this is an outpatient procedure, it would be covered under Medicare Part B.
When reviewing your surgery options, keep in mind that Medicare only covers the most basic lens implants. Your doctor may advise more advanced implants that provide better sight and focus, but will not be covered under Medicare. If you want these implants, you’ll need to pay more for your procedure. Some Medicare Advantage plans may provide coverage for advanced implants and you can find out if you’re covered by consulting with your insurance provider.
Does Medicare Cover Laser Cataract Surgery?
Medicare provides the same amount of coverage for procedures that use lasers as it does for traditional non-laser procedures. Since laser surgery is more expensive, you’ll need to pay more out-of-pocket for laser vision surgery. You’d still be required to only pay a 20% copayment for the procedure, but just as with traditional procedures, advanced implants will cost you more. If your Medicare Advantage plan provides vision coverage, you might save a bit of money on these upgrades.
How Much Should I Expect to Pay for Cataract Surgery?
Your cost for cataract surgery may vary depending on where you have it performed and other factors such as the type of procedure and lens implants you receive. Without any health coverage, the average cataract procedure costs roughly $4,000 per eye when including anesthesia. Medicare Part B will cover 80%, meaning it would cost you $800 per eye for a basic procedure.
Advanced implants can cost up to $2,500, and Medicare will not cover this upgrade. If you opt for a laser procedure, that can increase the cost by another $1,500 per eye. This brings your out-of-pocket expense to $1,100 per eye without considering the cost of premium implants. Most people can cut their costs with a Medicare Supplement policy, which is designed to cover most out-of-pocket expenses beyond what their Medicare plans reimburse.
Keep in mind that you must also meet your deductibles on your Medicare plan and Medicare Supplement plan before your copayment. Without Medicare Supplement coverage, you could expect your personal cost to be around $1,600 for a basic procedure on two eyes and over $6,000 if you undergo a laser procedure with advanced implants. A Medicare Supplement policy could reduce this significantly.
