Although Medicare's vision coverage is extremely limited, it does help pay for cataract surgery.
With limited vision coverage, a common question we get is, Does Medicare cover cataract surgery? The good news is yes, Medicare does cover cataract surgery, as well as most related services.
Cataracts typically develop slowly over time, making them a fairly common age-related vision problem. More than half of Americans over the age of 80 either have cataracts or have had cataract surgery. Keep reading to learn more about Medicare's coverage for this very common procedure.
How Does Medicare Cover Cataract Surgery?
Medicare covers cataract surgery when your doctor determines that it is medically necessary. Since the procedure is usually performed on an outpatient basis, coverage is through Medicare Part B. However, if your doctor recommends a hospital stay, Medicare Part A applies.
Your Medicare coverage for cataract surgery includes:
- Removal of the cataract using either lasers or traditional surgical techniques
- Basic intraocular lens (IOL) implants
- One pair of prescription lenses, e.g. eyeglasses or contacts, following the surgery
Medicare Part B also covers both presurgical and postsurgical services related to your cataract surgery.
Please note that Medicare does not cover advanced intraocular lens implants. If your provider recommends a more advanced IOL implant, ask plenty of questions to understand which costs will and will not be covered by Medicare.
Does Medicare Advantage Cover Cataract Surgery?
Since Medicare Advantage plans must provide the same benefits as Original Medicare (Parts A and B), they cover cataract surgery. How your Advantage plan covers cataract surgery may vary, though. For more information on costs and coverage, please call your Medicare plan provider.
Medicare and Eye Surgery
For any service, including cataract surgery, Medicare coverage depends on whether your healthcare provider accepts assignment. This applies to both the procedure and the medical supplier from whom you get your prescription eyeglasses or contact lenses (if applicable).
What Types of Cataract Surgery Does Medicare Cover?
Medicare covers two types of cataract surgery:
- Extracapsular removes the lens in a single piece
- Phacoemulsification uses ultrasound technology to break up the cloudy lens before removal
Once your doctor removes the cloudy, damaged lens, they insert the IOL.
How Much Does Cataract Surgery Cost?
The average out-of-pocket cost for cataract surgery under Original Medicare is a little over $200 if the procedure is performed in a clinic or ambulatory surgery center. You'll pay around double that if the surgery is performed in the outpatient department of a hospital.
Please note that cataract surgery costs vary according to a wide array of factors, including:
- Whether you need surgery on one or both eyes
- Which type of surgery your doctor recommends
- Your Medicare coverage (such as whether you have a Medigap plan or Medicare Advantage)
- Whether your procedure is performed in a clinic or hospital (your costs are higher through a hospital)
Where you live also plays a role. For example, costs are generally higher for most services in heavily populated or urban areas. Again, always ask whether your provider accepts assignment.
Medicare Part D and Cataract Surgery
Your surgeon may prescribe certain medications before or after your procedure. Check your Medicare Part D prescription drug plan's formulary to see whether it covers the prescription and what your out-of-pocket costs will be.
Does Medigap Cover Cataract Surgery?
Medicare Supplement Insurance plans, more commonly known as Medigap, cover a variety of out-of-pocket costs under Original Medicare. One of these is your Medicare Part B coinsurance or copayment. Medigap Plan K pays 50 percent of your Part B coinsurance while Medigap Plan L pays 75 percent. All other Medicare Supplement plans cover 100 percent of your Part B coinsurance or copayment.
What Are Cataracts?
Cataracts are cloudy areas that form in the lens of one or both eyes. They usually occur over time, but some people develop cataracts after an injury. They can also happen after surgeries to correct other eye issues, such as glaucoma.
Although cataracts are extremely common, you can help prevent them with a few lifestyle changes.
- Eat lots of dark, leafy vegetables (e.g. collard greens, kale, and spinach)
- Protect your eyes from the sun by wearing sunglasses and a brimmed hat
- Quit smoking
People over age 60 should get a dilated eye exam every 2 years. Routine eye exams are not covered by Medicare. However, most Advantage plans include this coverage.
In the early stages, cataract symptoms are mild and may include:
- A halo effect around lights
- Blurry or clouded vision
- Colors appear more faded
- Difficulty seeing at night
- Double vision (which typically gets better as the cataract gets worse)
- Needing to change your prescription lenses more often
- Sunlight, headlights, and lamps appear brighter
Conservative treatment (i.e. non-surgical) options are mainly about adjustments to help you see better, since cataracts cannot be cured. These options include wearing anti-glare sunglasses, installing brighter lighting, and using a magnifying glass for tasks like reading.
Who Needs Cataract Surgery?
Your doctor may recommend surgery if your cataracts start interfering with your daily life. This includes difficulty seeing while driving, reading, and watching television.
Medicare and Cataract Surgery FAQ
In this FAQ, we answer your most common questions about Medicare and cataract surgery.
Does United Healthcare cover cataract surgery?
If you have a Medicare Advantage plan through any private insurance company – including United Healthcare – it covers cataract surgery. Details of that coverage vary according to the plan and provider you choose.
Is Lasik surgery covered by Medicare?
No, Medicare does not cover Lasik surgery.
How much does cataract surgery cost?
If you don't have health insurance, cataract surgery ranges between $2,500 and $5,000 per eye. If you have Medicare, those averages are significantly lower – between $1,000 and $2,000. Medicare Part B covers 80 percent.
What does Medicare cover?
Your Medicare Part B benefits cover a variety of services related to your cataract surgery. This includes preoperative eye exams, the procedure itself, postoperative checkups, and one pair of prescription eyeglasses or contact lenses. Eye drops and similar medications should be covered by your Medicare Part D plan. This is true whether it's a standalone drug plan or Medicare Advantage Prescription Drug plan (MA-PD). Check your plan's drug formulary.
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