Does Medicare Cover Cataract Surgery?

Most Americans aged 65 or over are covered by Medicare—a federal health insurance program. It also covers younger people with certain health conditions. 

Medicare includes insurance for many common health conditions—including cataract surgery. However, depending on the type of cataract procedure you opt for, it may or may not cover every element.

Everything You Need to Know About Medicare & Cataract Surgery

• Medicare cataract surgery: what’s covered
• Medicare cataract surgery: what isn’t covered

Medicare cataract surgery: what’s covered

Medicare coverage can be very confusing. There are multiple plans and different covers, not to mention the sometimes overly technical wording. The most common plan is Original Medicare, which includes Part A and Part B. There are also supplemental plans to purchase if you choose—Part C and Part D. 

To make things even more complicated, some people also buy a supplement, known as Medigap. This covers extras that aren’t included in Original Medicare.

So, let’s break down the general meaning of what this means when it comes to cataract surgery.

Original Medicare plans cover:

• An outpatient cataract operation: Most procedures are done on a day-patient basis, so this would be covered under Medicare Part B.
• Inpatient/hospital costs: Most people don’t need to stay in hospital for a cataract operation. But if you did, this would usually be covered under Medicare Part A.
• Pre- and post-op cataract appointments: Seeing your eye doctor before and after cataract surgery should be covered under Medicare Part B.
• The basic cataract operation: This applies to what’s known as traditional cataract surgery. This is covered under Medicare Part B.
• A basic intraocular lens (IOL): A monofocal IOL (the artificial lens that replaces the one that’s removed during the operation) gives focused vision at either near or far distance. This is covered under Medicare Part B.
• Supportive eyeglasses: A monofocal IOL usually supports distance vision. You’ll need to wear eyeglasses to support near vision (or vice-versa if you choose near over far focus). Medicare Part B covers one pair of eyeglasses.

Medicare cataract surgery: what isn’t covered

Unless you have Medicare Parts C, D, or Medigap, then it’s likely that the following aren’t covered.

• Laser-assisted cataract surgery: This is a more expensive procedure and is needed if you choose a more advanced IOL.
• Advanced IOL: There are many of these, including those that provide focused vision at multiple distances.
• Prescription medications: If you need these before or after surgery, they might not be covered by Medicare.
• Additional pairs of eyeglasses: Medicare generally only covers one pair.

If you have Medicare Parts C and D, and/or Medigap, then you should speak to your healthcare professional as to what—if any—of the extras might be covered.

Whatever Medicare cover you have, there’s likely to be at least some expense. Your deductibles, out-of-pocket limits, and more are all dependent on your individual policy. You should discuss this with your chosen medical facility to determine exactly how much you’ll need to pay.

You can also choose to have a more expensive procedure, such as laser-assisted surgery and a higher level of IOL and pay the difference. Medicare will still cover the cost of the basic procedure. You should only have to pay the shortfall.

Contact the WBEC for Both Private and Medicare Cataract Surgery

As one of the best facilities in the country for all things cataract-related, it’s not uncommon for people to travel hundreds (or thousands) of miles to get treatment. The West Boca Eye Center is led by Brent Bellotte M.D., one of the best cataract surgeons in the world.

Whether your procedure is fully funded by Medicare, you’re self-paying, or choose a hybrid Medicare-upgrade combination, we can help.

Visit https://www.westbocaeyecenter.com/services/cataract-surgery for more information or call our friendly team today to discuss.

Most Americans aged 65 or over are covered by Medicare—a federal health insurance program. It also covers younger people with certain health conditions.

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