Does Medicare Cover Cataract Surgery?

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Key Takeaways:
  • 80% of the cost of cataract surgery is covered under Part B.
  • Coverage is the same whether or not laser technology is used.
  • Most Medicare Advantage plans will cover cataract surgery.

Simply put, Medicare does cover cataract surgery. However, there are multiple types of cataract surgery, and Medicare only covers one very specific set of procedures.

This set includes:

  • Cataract removal
  • Lens implants
  • One set of eyeglasses or contact lenses

Most cataract surgery isn’t any more complex than the items included above, but there are a few special circumstances where your surgery may not be fully covered. We will discuss these special circumstances in more detail later on. It’s important to emphasize that Medicare will cover one set of eyeglasses or contact lenses after your surgery, even though Medicare does not usually offer this coverage.

Does Medicare Cover Laser Cataract Surgery?

The short answer to this question is yes.

Medicare will cover your cataract surgery, regardless of the method used. So, whether the surgery is performed using a laser or a more traditional technique, the only thing that matters regarding your coverage is which procedures are performed. This means that if you’re going to undergo a laser cataract surgery, you will still receive the same coverage.

How Can I Know if My Lens Implant is Covered?

There are multiple types of cataract surgeries, and some of the more complex or involved procedures that will not be covered by Original Medicare. With most cataract surgeries, the type of lens that is used is called a monofocal lens. It is important to note that Medicare will only cover monofocal lens implants.

Lenses that aren’t covered by Medicare are:

  • Multifocal
  • Accommodative
  • Toric

Cataract Surgery: Is it Medically Necessary?

Medicare will only cover your cataract surgery if it is deemed as being medically necessary. In the majority of instances, procedures like cataract surgery will be deemed medically necessary. However, it will be useful to make sure that this is the case before you proceed with the surgery. Otherwise, if you discover that Medicare will not pay for it after the fact, it could put you in a real financial bind.

Which Parts of Medicare Do You Need For Cataract Surgery?

Medicare is divided into various parts, each of which covers different types of services. Cataract surgery, like many surgeries, can be done in an outpatient setting or a hospital, and can also involve additional follow-up services and prescription drugs.

Medicare Part A And Cataract Surgery

Medicare Part A is the portion of Original Medicare that covers your in-hospital care. Cataract surgery is seldom performed in a hospital setting, but if it is it will be covered by Part A. In 2020, the Part A deductible is $1,408, so keep that in mind if you get your surgery done in a hospital.

Undergoing Cataract Surgery With Part B

Part B covers your outpatient care and is most likely what you will use to cover your cataract surgery. Under Part B, only 80% of the cost of your cataract surgery will be covered. You will be responsible for the remaining 20%. Part B will cover your lens implant, removal, and the prescription glasses or contact lenses covered for the procedure. The Part B deductible is quite low at $198.

Medicare will only cover your cataract surgery if it is deemed as being medically necessary.

Does Medicare Advantage Cover Cataract Surgery?

Medicare Advantage, also known as Part C, offers you a way to receive your Medicare benefits through a private insurance company. Because of this, the plans tend to vary a lot throughout the country, both in price and in coverage. However, many Part C plans will cover cataract surgery. As some plans may cover more than Original Medicare, it is worthwhile to research each in detail if you already have a Part C plan.

Do You Need Part D Coverage For Cataract Surgery?

Generally speaking, you do not need Part D coverage for cataract surgery. However, there are some instances where it may prove useful. For example, if you need drugs prescribed after your surgery due to some special health conditions, these will likely be covered by Part D. If you do not have Part D, such medications may not be covered.

Most people will not need additional prescription drugs following cataract surgery, but this concern may be relevant to your situation. For this reason, it is wise to discuss the possibility of needing additional medication after your surgery with your physician beforehand, just so you know exactly what to expect.

What Next?

In general, cataract surgery is fairly simple when it comes to Medicare coverage. This is because the coverage provided is consistent, and most people will be covered comprehensively with just their basic Original Medicare. However, it’s always important to check on the specific details of your plan with your insurance company and your doctor before you have any procedure to avoid any unpleasant surprises.

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