Will Medicare Cover Cataract Surgery?

Vision coverage is a murky area in Medicare. It’s known as one of the areas where Medicare coverage doesn’t apply and is seen as one of its shortcomings. This can be alarming as a policyholder if you are concerned about cataracts, because you already have a 20% risk of developing cataracts at age 65, and by age 80, that risk climbs to 50%. Fortunately, if you need cataract surgery, Medicare will cover it.

What Does Cataract Treatment Involve?

It begins with symptoms. Cataracts are a clouding of your eye’s natural lens, causing blurred or double vision and feeling like you’re looking through a dim, foggy window.

Cataract severity varies. Sometimes surgery isn’t necessary, and your optometrist may prescribe glasses or contacts instead. Medicare won’t cover this.

They won’t go away on their own. A doctor may have to remove your eye’s natural lens and replace it with an artificial lens. Medicare will cover this. 

When Does Medicare Cover Cataract Treatments?

Medicare Part B covers cataract surgeries because they’re performed on an outpatient basis.

Medicare will negotiate a price with your physician and then cover 80% of that cost after you meet your $233 deductible. The typical cost of cataract surgery without Medicare is $4,366, but with Medicare Part B, you’ll pay roughly $826.

What Other Costs Will Medicare Cover?

Part B covers eye exams that diagnose other serious eye conditions, as well as the pre-surgery exam.

Surgery also isn’t presented as one big expense. It’s a culmination of many costs – many of which Medicare covers, including anesthesia, cataract removal, and the artificial lens itself.

Aside from surgery, Part B covers your follow-up care (up to 12 months), and one pair of prescription glasses or contacts after surgery.

What Impacts Costs?

How your surgery is performed, the materials used, and the surgeon performing the operation will impact your overall cost. For example – if you get laser cataract surgery, you’ll pay more than you would for traditional cataract surgery. The artificial intraocular lens can also lead to higher costs, such as those for correcting presbyopia. Some surgeons have higher rates than others, too.

How Can I Save More?

You have a few strategies for lowering your costs. You can find surgeons who offer lower rates for your procedure. If you enroll in a Medicare Supplement Plan (Medigap), you can get all remaining out-of-pocket costs covered as long as your physician accepts Medicare. You may be able to save more on cataract surgery with Medicare Advantage, as well as get coverage for routine vision care. However, you cannot have Medigap and Medicare Advantage together.

Save More, Get More

ReLion Insurance Solutions is your go-to for all Medicare insurance needs. We can answer any questions you may have about your policy and enroll you in the best Medicare plan that is right for your health – and your wallet. To learn more, call us today at (858) 999-2858.