Published on Dec 22, 2024 5 min read

Is Cataract Surgery Covered by Medicare? Explained Simply

If you or someone you know has cataracts, you might wonder if Medicare can help cover the cost of surgery. Cataract surgery is a common procedure that helps improve vision by replacing a cloudy lens in the eye with a clear artificial one. Fortunately, Medicare usually offers coverage for this surgery, but there are some details and rules to understand. This article will explain in simple terms how Medicare covers cataract surgery and what you might need to pay out of pocket.

What is cataract surgery?

Cataract operation is a type of surgery that may involve the extraction of your natural lens, which has gone foggy, and the implantation of an artificial one. A cataract is the alteration in the lens of the eye that results in loss of vision, brightness intolerance, and night blindness. It is commoner in this age bracket but may also result from other contribitors like genetics or conditions like diabetes.

The actual surgery itself may only take approximately 20 minutes to perform and is typically done on an outpatient basis. It involves making a small incision in the eye, breaking up and removing the cloudy lens, and replacing it with an artificial one called an intraocular lens (IOL).

How to Check Your Medicare Coverage for Cataract Surgery

Before scheduling your cataract surgery, it's essential to confirm that Medicare will cover the procedure and associated costs. You can do this by contacting Medicare directly or speaking with your doctor's office. They can provide you with a cost estimate and let you know if there are any additional expenses you may need to pay out of pocket.

It's also crucial to ensure that the surgeon performing the procedure accepts Medicare assignment. This means they agree to accept the Medicare-approved amount as full payment for the surgery, so you won't be charged more than what Medicare allows.

Does Medicare cover cataract surgery?

In most cases, Medicare Part B (Medical Insurance) will cover cataract surgery if your doctor has deemed it medically necessary. This means that the surgery is needed to improve or preserve your vision and prevent further complications related to your cataracts.

Medicare Part B will cover 80% of the cost of the procedure, and you are responsible for paying the remaining 20%. However, if you have a Medigap (Medicare Supplemental) plan, it may cover some or all of this 20% coinsurance.

Keep in mind that Medicare only covers the surgical procedure itself and any costs associated with the implantation of a standard intraocular lens. If you choose to upgrade to a premium lens, such as those that correct for astigmatism or near vision, you may have to pay an additional fee out of pocket.

Exclusions from Coverage

While most cataract surgeries are covered by Medicare, there are some exceptions.

Routine Vision Exams

Medicare does not cover routine vision exams, including those for glasses or contact lenses. However, if you have a medical condition like cataracts that requires surgery, Medicare may cover the pre-operative and post-operative visits related to your procedure.

Additional Testing and Procedures

If additional testing or procedures are required during your cataract surgery, such as correcting astigmatism or inserting special lenses, they may not be covered by Medicare. It's important to discuss these options with your doctor beforehand to understand any potential out-of-pocket costs.

Out-of-Network Providers

If you choose to have your cataract surgery performed by an out-of-network provider, Medicare may not cover the procedure at all. It's crucial to make sure that your doctor accepts Medicare assignment and is within your network before scheduling the surgery.

How much does cataract surgery usually cost?

The cost of cataract surgery varies based on factors such as the type of lens selected, the surgeon’s fees, and any additional tests or procedures needed. On average, the procedure ranges from $3,000 to $5,000 per eye without insurance. However, Medicare Part B often covers 80% of medically necessary cataract surgeries, significantly reducing your out-of-pocket expenses.

It's also worth noting that if you opt for premium intraocular lenses, such as multifocal or toric lenses, you will likely have to pay the additional cost out of pocket, as these are not covered by Medicare. The price of premium lenses can range from $1,500 to $3,000 per eye. Be sure to discuss all options and associated costs with your doctor before the procedure to avoid surprises.

What about pre and post-operative care?

Medicare also covers pre and post-operative care related to your cataract surgery. This includes any visits with your surgeon or other healthcare providers, as well as any necessary medications prescribed for the procedure.

It's essential to follow your doctor's instructions carefully before and after surgery to ensure a successful outcome. If you encounter any issues or complications during the recovery process, be sure to contact your doctor and Medicare right away.

How to prepare for cataract surgery

Before your surgery, your doctor will provide you with specific instructions on how to prepare. It's essential to follow these instructions carefully to ensure the best possible outcome. Some general tips for preparing for cataract surgery include:

• Follow pre-surgery guidelines: Your doctor may instruct you to avoid certain medications or foods before and after your surgery.
• Plan for post-operative care: You may need assistance at home during the first few days of recovery, so make arrangements beforehand.
• Have a list of current medications: Make sure to provide your doctor with a list of all medications you are currently taking, including over-the-counter and supplements.
• Wear comfortable clothing: You will likely be asked to change into a hospital gown before the procedure, so wear comfortable clothes that are easy to remove and put back on.

Conclusion

Cataract surgery is a common and effective procedure for improving vision and quality of life. If you have Medicare, it's essential to understand your coverage and any associated costs before scheduling the surgery. By following these tips and preparing properly, you can ensure a successful cataract surgery experience with minimal out-of-pocket expenses. Remember to always consult with your doctor regarding any questions or concerns about your cataract surgery and Medicare coverage.