Cataracts are a sight-threatening condition but, happily, one that can be successfully treated with various surgical options. When diagnosed, one of the most commonly asked questions is, “Does Medicare cover cataract surgery?”

In general, and as long as the procedure is considered to be medically necessary, the answer is yes. However, it’s likely that not all components will be covered, meaning you may have to fund various aspects of the procedure. 

Cataract Surgery: What Components Does Medicare Cover?

  • Basic cataract surgery
  • Choice of lenses

Basic cataract surgery

For anyone over the age of 65, the government Medicare program covers the basic costs of cataract surgery. This applies to the two major kinds of surgeries, Phacoemulsification and Extracapsular, both of which involve the implantation of an intraocular lens (IOL).

In general, Medicare covers the following aspects of either procedure:

Removal of the cataract

Implanting the IOL

A single pair of contact lenses or eyeglasses post-procedure

Choice of procedure and lenses

For the procedure to be considered a medical necessity (and therefore covered by Medicare) an ophthalmologist will need to determine that your vision is significantly affected. If you choose to undergo premium cataract procedures, such as laser cataract surgery, or if you choose certain IOLs, you may have to fund the extras yourself.

 Medicare Explained 

  • The different elements of Medicare
  • Medigap

The different elements of Medicare

Medicare is divided into four components, as follows:

Part A: This covers hospitalization and associated costs. Cataract surgery doesn’t generally necessitate a hospital stay, but should it happen this would be covered.

Part B: Covers outpatient and medical costs, so this is the part of Medicare that covers cataract surgery. This will also cover pre and post-ophthalmologist appointments related to your cataract surgery.

Part C: This is known as an Advantage Plan, and will cover the same as parts A and B. Whether or not it covers all or part of the treatments will depend on the level of plan you’ve selected.

Part D: Certain prescription medications are covered by this component. Those on the list will be covered, but any that aren’t will need to be paid for.

Medigap

Supplement plans, known as Medigap, often cover extra expenses. You’ll need to speak to your provider to determine exactly what or what’s not included in your particular policy. 

 Determining Costs and Medicare Cover

  • Pre-op consultation
  • Finance plans
  • Other factors

Pre-op consultation

This is the stage during which your different options will be discussed, including what is and isn’t covered by Medicare. Your eye surgeon will talk to you about the exact cataract surgery procedure that best suits your condition and the IOLs on offer.

Finance plans

Ophthalmologists and eye centers often offer finance plans for on-Medicare products and procedures.

Other factors 

Even if covered by Medicare, you’ll likely have to cover some out-of-pocket expenses. The following will influence how much (or little) you have to pay towards the procedure.

Any other health insurance policies held

Your particular Medicare plan

If you have Medicaid

Your particular deductibles and out-of-pocket limits

Medications you’ll need and if they’re covered by Medicare Part D

Any other medical conditions that might call for more complex cataract surgery

Veteran benefits

Contact the West Boca Eye Center for Medicare-Funded Cataract Surgery

The best way to determine whether some or all of your cataract procedure will be covered is to speak to the experts. World-leading eye surgeon, Brent Bellotte MD., of the West Boca Eye Center, specializes in cataract surgery and will help you understand whether or not Medicare does cover your cataract surgery. 

To find out more visit westbocaeyecenter.com and book your appointment now.