Medicare covers medically necessary cataract surgery
- Jim Miller: Savvy Senior
- August 27, 2024
- 537
Dear Savvy Senior,
How does Medicare cover cataract surgery? My eye doctor recently told me I’ve developed cataracts and should consider making plans for surgery in the next year or so.
Almost 67
Dear Almost,
Like gray hair and wrinkles, cataracts are an inevitable part of the aging process. Eventually, everyone — usually in their 60s — will develop cataracts, a condition that causes cloudy or blurry vision. The only way to correct this is through cataract surgery.
Fortunately, Medicare does cover medically necessary cataract surgery, which includes removing the cataract and implanting a standard intraocular lens. This is a small, lightweight, clear disk that replaces the focusing power of the eye’s natural crystalline lens to restore clear vision. This procedure is performed using traditional surgical techniques or lasers.
This coverage can be a substantial savings because cataract surgery often costs about $1,800-$2,800 per eye.
Cataract surgery is usually an outpatient procedure, covered under Medicare Part B. Once you pay the annual Part B deductible, which is $240 in 2024, you’re responsible for the Part B coinsurance.
That means you’ll pay 20% of the cost for covered services yourself. If you have a Medicare supplemental policy, also known as Medigap, you’ll have full or partial coverage for the 20% Part B coinsurance.
If you happen to be enrolled in a private Medicare Advantage plan, rather than original Medicare, you’ll also have coverage for cataract surgery. However, you may have to pay different deductibles or co-payments and need to use an in-network provider. You’ll need to call your plan to find out its coverage details before you schedule surgery.
What’s not covered?
Be aware Medicare only covers cataract surgery with standard (monofocal) intraocular lenses, which improves vision at just one distance, so you may still need glasses for close-up vision. Medicare will not cover premium (multifocal) intraocular lenses, which can correct vision far away, up close and in between, so you can go glasses-free after surgery.
Premium intraocular lenses are expensive, costing approximately $1,500-$4,000 per eye, which you would be responsible for if you choose to upgrade. Talk with your doctor about your options and costs before your surgery.
Are eyeglasses covered?
Even though Medicare usually doesn’t cover eyeglasses or contact lenses, it will pay 80% for one set of corrective glasses or contacts after cataract surgery. Medicare, however, limits its coverage to standard eyeglass frames and lenses. If you want to get deluxe frames, progressive or tinted lenses, or scratch-resistant coating for glasses, you’ll need to pay those costs yourself. Medicare also requires you purchase the glasses or contacts from a Medicare-approved supplier.
Also, if you have any post-surgery complications or problems that are deemed medically necessary to address by a doctor, Medicare covers those expenses too. Any drops, antibiotics or other medication prescribed after your surgery would be covered by Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage.
Send your senior questions to Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.SavvySenior.org.