Does Medicare Cover Cataract Surgery?

Summary: Medicare cataract surgery coverage is available through Part B benefits if medically necessary, but there are many considerations that go along with the procedure. Estimated Read Time: 22 mins

Navigating your vision health and Medicare benefits can be tricky. While vision healthcare isn’t typically covered by Medicare, medically necessary procedures can be exceptions. This means Medicare cataract surgery may be possible, depending on the issue at hand.

If they are elective, Medicare coverage for cataract surgery won’t come through Original Medicare (Medicare Part A and Part B) or Medicare Supplement (Medigap) plans. Other solutions are available, or you can cover the expenses out-of-pocket.

Furthermore, there are Medicare Advantage plans that are more friendly toward vision benefits and can also cover cataract surgery. But while you can’t have both a Medigap and Medicare Advantage plan at the same time, depending on your healthcare needs, you should be able to find a viable option to help you keep your medical expenses low.

As you age, healthcare becomes even more of a focal point, including your vision, as it can begin to fade. Knowing how to stay protected from costly procedures is essential. Below, we’ll review your options, how you can help cut healthcare costs, and the scenarios seniors may face when needing cataract surgery.

Does Medicare Pay For Cataract Surgery?

Medicare cataract surgery coverage is available so long as the procedure is medically necessary. You’ll receive your healthcare from an ophthalmologist in an outpatient setting. Therefore, Medicare Part B will cover your healthcare expenses.

But it’s important to highlight some parameters affecting how much your Medicare benefits will pay for your care, including cataract surgery. Here is what you’ll receive if your procedure follows the Medicare guidelines for cataract surgery:

• Although Medicare Part B will cover 80% of your expenses for your procedure, once meeting your Medicare Part B deductible, there are still out-of-pocket costs to consider.
• These expenses include your Medicare Part B premiums, copays, and coinsurance. In rare cases, you may also face Part B excess charges in states that allow them.
• Medicare Supplement coverage can help you cover the remaining costs when using Original Medicare benefits alone for cataract surgery.
• Alternatively, Medicare Advantage (Medicare Part C) benefits may also provide better Medicare coverage for cataract surgery, depending on a variety of personal factors.

Regardless of Medicare benefits paying for your procedure, it must be deemed medically necessary for coverage, and not all cataract surgeries are.

For your Medicare benefits to cover the cost of cataract surgery, your healthcare provider must submit to the Medicare program that your procedure is medically necessary for your health.

So, is cataract surgery covered by Medicare? Yes, it can be. But it depends on your condition and the need for the procedure. However, undergoing surgery is only part of the healthcare you may need regarding your cataracts. Let’s review what is specifically covered by your Medicare benefits below.

What Does Medicare Cover for Cataract Surgery?

Medicare cataract surgery coverage includes the procedure itself, services from the healthcare providers delivering your procedure, and a pair of standard glasses or contact lenses. You will also receive coverage for things like anesthesia, provided during your surgery and medically necessary for your healthcare.

Should medication become necessary while receiving outpatient care, your Medicare coverage for cataract surgery will include these medications via your Part B benefits. If you are enrolled, medication that is necessary outside of your surgery and provided through a prescription can be covered by Medicare Part D.

What Type of Lens Does Medicare Cover for Cataract Surgery?

Standard intraocular lenses (IOLs) are cataract lenses covered by Medicare benefits. Used to improve the vision for patients at a distance, traditional IOLs can be used for cataracts. Because they are monofocal, vision must be assisted with glasses in most cases for closer viewing in many cases.

There are other lenses available that use advanced technology. Premium IOLs can offer a broader sight range and are provided by various brands. Furthermore, there are also refractive lens exchanges that patients may seek out. However, these lenses are not covered by Medicare benefits.

The Cost of Cataract Surgery With Medicare

The average cost of cataract surgery with Medicare can be $361 at non-hospital facilities performing the operation and as much as $573 when receiving this healthcare in an outpatient setting from a hospital. They break down as follows:

Ambulatory Surgical Centers

• Doctor Fees: $746
• Facility Fees: $1,062
• Total: $1,808
• Amount Medicare Covers: $1,445

Hospital Outpatient Departments

• Doctor Fees: $746
• Facility Fees: $2,120
• Total: $2,866
• Amount Medicare Covers: $2,292

However, it’s important to remember that every surgery is different. Cataract surgery cost with Medicare can still vary, as you may face additional fees or expenses that come from seeing multiple healthcare providers. As both figures are national averages, it’s important to remember that where you live will affect how much you pay.

Suppose you want to cover the remaining costs for your cataract surgery through Medicare benefits. In that case, you will need to enroll in a Medicare Supplement.

Does Medicare Pay For Cataract Surgery With Astigmatism?

No, in most cases, you can’t receive coverage for cataract surgery from Medicare benefits for astigmatism. Here’s why:

• In many cases, you can treat astigmatism with glasses or contacts. Therefore, it’s not medically necessary for you to undergo surgery. A key component for any procedure receiving coverage from Medicare benefits.
• To fix astigmatism through cataract surgery, you’ll likely need to receive a type of lens that is not covered by Medicare benefits. Remember, lenses using advanced technology are not included.

The combination of those who have astigmatism having viable options combined with the inaccessibility to the necessary technology to complete the procedure means that Medicare benefits aren’t really an option.

If you do suffer from astigmatism, glasses or contacts may be an alternative route. Otherwise, you’ll likely need to pay for it out of your own pockets. Even when enrolling in a separate vision plan, it’s unlikely that your vision insurance will offer coverage for this procedure.

Is Cataract Surgery Covered by Medicare Advantage Plans?

Yes, the cost of cataract surgery with Medicare Advantage is covered by your benefits. This is because Medicare Advantage plans must cover the same medical procedures as Original Medicare benefits, including cataract surgery used to implant an intraocular lens when medically necessary.

The key point to remember is when it comes to Medicare Advantage plans, while many enrollees benefit from the coverage, some restrictions come with your policy. Specifically, unlike Medicare Supplement plans, there are networks to be aware of.

This can be a limiting factor for seniors looking to receive healthcare from their preferred providers and use their benefits. If you are looking to help cover the expenses of your cataract surgery or any other Medicare-approved healthcare procedure without the worry of networks, Original Medicare and Medigap benefits may be the right option for you. Enrolling in both Medicare Supplement and Medicare Advantage is not allowed.

Additionally, suppose you find that a Medicare Advantage plan is your best option after speaking with a licensed Medicare agent. In that case, you’ll want to know whether or not your healthcare provider is within your network. You can search for cataract surgeons that accept Medicare using the program’s find and compare tool, but you will still need to refer to your individual Advantage plan to determine whether or not they are in your network.

Does Medicare Cover Multifocal Lens for Cataract Surgery?

No, multifocal lenses aren’t covered following cataract surgery by Medicare benefits. Remember, when Medicare covers cataract surgery, the type of lens used, standard IOLs, are monofocal. You can correct issues that persist after your surgery with glasses or contacts instead of receiving multifocal lenses through cataract surgery.

Because vision insurance isn’t covering cataract surgery in most cases, multifocal lenses aren’t usually covered through other means either. This is another situation in which, even with Medicare benefits and ancillary coverage, you’ll likely pay for the healthcare service on your own.

Does Medicare Cover Glasses After Cataract Surgery?

Yes, Medicare post-cataract glasses are available as part of your benefits. This equates to a one-time benefit following your procedure that includes either a pair of eyeglasses with standard frames or one set of contact lenses. To qualify, your cataract surgery must meet the standards of Medicare and be medically necessary, as glasses are typically not covered by your benefits.

If you require additional pairs, you’ll need to purchase them on your own or through your vision benefits. But Medicare doesn’t provide such coverage. Furthermore, the same applies if you are looking to receive premium frames or lenses.

There are also stipulations that can change from location to location, which you’ll want to be aware of. This is because to use your benefits, you’ll need to understand Medicare post-cataract glasses billing.

Your Medicare benefits allow for you to receive post-cataract glasses, but there are local coverage determinations (LCDs) that may have policy limits you’ll need to abide by. LCDs can even stipulate that if you have cataract surgery and only purchase new lenses but never get new frames, you won’t be able to get new frames later on unless you have a cataract extraction on another eye.

LCDs also dictate that if you undergo cataract surgery on one eye but have the procedure done on another eye later without receiving your glasses or contacts between the two, your Medicare will only cover your eyewear following your second cataract surgery.

Does Medicare Part B Cover Cataract Surgery?

Yes, Medicare Part B covers 80% of the costs for your cataract surgery, so long as it is a qualifying procedure and deemed medically necessary. This includes glasses, as mentioned above. But you’ll still need to cover various expenses, such as your deductible, additional fees, and Part B excess charges in some cases.

The alternative is enrolling in either Medicare Supplement or Medicare Advantage coverage. With these benefits, you may find that your cataract surgery covered by Medicare will cost you nothing out of pocket.

Does Medicare Cover Toric Lens Cataract Surgery?

No, your Medicare benefits aren’t going to cover toric lenses for your cataract surgery. Although a solution if you’re suffering from astigmatism, as mentioned above, other options exist, and Medicare also doesn’t rely on lenses using advanced technology.

A toric lens can help those suffering from astigmatism and also provide better distance vision. But like other lenses outside of standard IOLs, if you’re interested in getting toric lenses, you’ll have to pay for them from other means outside of Medicare benefits. Often, this means paying for them on your own.

Does Medicare Cover Cataract Surgery and Lens Implant?

Specifically, your cataract surgery Medicare coverage is towards traditional procedures or those using lasers. It will cover your lens implant but only for standard IOLs. Additionally, any surgery must be medically necessary.

Therefore if you are looking for any of the following, you’ll have to pay for either the entire procedure or the difference out of your own pockets:

• Elective surgeries, which include procedures for cataracts, are not covered.
• If your surgery involves lenses relying on advanced technology, Medicare will not pay for the lenses.
• Medicare covers tests and exams that are necessary before cataract surgery, but if your procedure is not medically necessary, you’ll likely need to pay for these out of pocket as even vision coverage doesn’t typically cover them.

Does Walmart Accept Medicare for Glasses After Cataract Surgery?

Walmart Vision Center locations accept Medicare. Thus, you can use your benefits for a pair of glasses after cataract surgery. This benefit is provided once for those who qualify, but it’s important to double-check your local Vision Center. While most accept Medicare coverage, not all do.

Therefore, coverage will vary from location to location. Those that do accept Medicare must also take Medicare Supplement plans as well. They may also accept Medicare Advantage plans, but if the individual Walmart Vision Center you are going to is not in your network, you may have to pay a higher cost or be unable to use your plan’s benefits at all.

Does Medicare and TRICARE for Life Cover Cataract Surgery?

Yes, if you have Medicare and TRICARE for Life, cataract surgery is covered by both benefits, although not necessarily at the same time. Furthermore, if you have a Medigap plan, your Medicare Supplement benefits also cover this procedure, but it can be complex in which set of benefits covers you at the time.

This is because there are state restrictions that can apply, and there are also considerations that come into play depending on your employer-sponsored coverage that dictates which program pays for your surgery. The bottom line, before committing to your operation, you’ll want to sit down with your licensed Medicare agent to understand how your personal benefits cover you for cataract surgery.

Does Medicare Pay For Monovision Cataract Surgery?

If you’re suffering from conditions in which monovision cataract surgery is medically necessary, your Medicare benefits will cover the procedure. Monovision occurs when your dominant eye is corrected to view things at a distance while your opposite eye is corrected to help view objects nearer to you. However, each eye can receive the opposite treatment as well.

Technically, the term “monovision” isn’t quite correct, but that’s how it’s known. Medicare cataract surgery coverage can be complex, as you can see, with many different scenarios available. Because only certain surgeries are approved, it’s always important to check with your healthcare team about the specific services you’ll be receiving.

Does Medicare Require a Physical Before Cataract Surgery?

Despite studies from The New England Journal of Medicine showing that pre-op testing is usually unnecessary, you may be required to take a physical before your procedure. Medicare benefits will cover such testing, including your physical, complete blood counts (CBCs), and electrocardiograms (EKGs).

Such testing and consultations will often be a time in which you and your healthcare provider go over the surgery and make decisions regarding receiving anesthesia during the operation.

Because these tests are part of your medically necessary procedure, they are covered, which is a great relief. Physicals alone can cost several hundred dollars depending on where you live if you don’t have insurance. With Original Medicare benefits and the right Medigap plan, you can cover these expenses rather than paying for them out of your funds.

Does Medicare Supplement Cover Cataract Surgery?

Yes, Medicare Supplement plans cover the procedure because benefits from Original Medicare cover cataract surgery. The same guidelines will apply. You’ll need your doctor to provide proof that your surgery is medically necessary, but if they do, you’ll be covered.

Also known as Medigap plans, beneficiaries can end up paying no out-of-pocket costs when enrolled. This is because your benefits supplement, or fill in the gap, for your Original Medicare benefits. Therefore, the 20% costs that may be left over after using Medicare Part B coverage may be covered entirely.

Unlike Medicare Advantage plans, you’ll also enjoy benefits without the worry of a network. Therefore, you can undergo your cataract surgery procedure at any facility accepting Medicare benefits, which is the large majority of healthcare facilities in the country. Those with Medicare Advantage plans may have to seek care from a provider that is not their preferred doctor.

There are 12 lettered plans available. Each is going to provide a varying level of benefits, which is going to affect not only how much you pay in premium but also how many benefits you receive for covering the cost of your healthcare at the time of service.

This is why it’s important to speak with a licensed Medicare agent before signing up for benefits. If you’re looking to help cover your healthcare costs, choosing the right supplemental coverage can be the key. But you’ll need to compare your needs, the plans available, as well as the companies offering coverage in your area for the best results.

Does Medicare Plan F Cover Cataract Surgery?

Yes, though formally known as Medicare Supplement Plan F or Medigap Plan F, cataract surgery is covered. Remember, there are 12 lettered Medigap plans, and they each cover the same Medicare-approved procedures, so long as they are medically necessary.

Medicare Supplement Plan F offers the widest range of benefits and can leave you with no costs after cataract surgery. But there is a big caveat that has come about since the somewhat recent changes to Medicare have taken place.

If you were eligible for Medicare benefits before January 1, 2020, you can sign up for Medigap Plan F to enroll in the most comprehensive supplemental coverage available. Unfortunately, for those eligible after the cutoff date, you’ll need to seek alternative options, although comparable solutions do exist.

Does Medicare Plan G Cover Cataract Surgery?

Yes, Medicare Plan G, formally named Medicare Supplement Plan G or Medigap Plan G, will cover cataract surgery that is medically necessary. As part of one of the 12-lettered Medigap plans, the same rules apply for covering healthcare services, and Part G is one of the most popular options available.

This is partly because of the eligibility restrictions imposed on Medicare Supplement Plan F. While you’ll still have to cover your Medicare Part B deductible, Medigap Plan G offers the same benefits as Plan F, making it the most comprehensive level of benefits for newly eligible Medicare beneficiaries.

When you compare the average cost of cataract surgery to your yearly deductible, $226 in 2023, it’s easy to see how supplemental coverage can be a better option, even with the expense. This is particularly true for seniors who go to the doctor’s office often for other forms of healthcare.

But everyone has different needs for their budget and healthcare, regardless of cataract surgery or other procedures. Taking in the full scope of your needs will provide you with the best course of action for mitigating your healthcare expenses.

Remember, having coverage such as Medicare Supplement Plan G will deliver more benefits, but you’ll also have to pay a higher premium as a result. There are many other options available, many with lower monthly premiums. The key is to find the right coverage for your needs rather than simply enrolling in the coverage with the widest array of benefits.

Does Medicare Plan A Cover Cataract Surgery?

Yes, if you are enrolled in Medicare Supplement Plan A (Medigap Plan A), the formal name for Medicare Plan A, you can cover the costs of your cataract surgery. However, unlike the previous two Medigap plans highlighted, you can expect to pay much more. This is because Medicare Supplement Plan A provides the lowest number of benefits out of the supplemental coverage options available.

In the case of supplemental coverage from Medicare and cataract surgery, this may not affect you as much, although there are Part B excess charges that you come across in rare situations. Furthermore, healthcare is much more than any one singular procedure and should be considered wholly before deciding on a plan.

Again, if you’re looking to maintain low healthcare costs, reviewing your needs and comparing the benefits available to you is going to help you save money both in the present and the future so that you are prepared for what comes your way.

Does Medicare Cover Refraction After Cataract Surgery?

No, refraction tests are not covered by Medicare benefits following cataract surgery, and by extension, this means that those enrolled in Medigap coverage are also not covered. Furthermore, although some Medicare Advantage plans do offer benefits for routine eye exams, it’s unlikely that your coverage will cover refraction tests.

Following cataract surgery, it’s common that refraction vision tests take place a few weeks following your procedure. This provides you the opportunity to address refractive errors, which can still affect patients through blurry vision at varying distances. A particular concern for patients seeking 20/20 vision and unhappy with the results of their operation. If you are near 20/20 vision, the test is typically unnecessary.

Vision coverage can help cover eye exams, unlike Medicare benefits. However, you’ll want to be sure of what is covered by your individual policy. When it comes to refractions, this test is typically not covered by vision insurance either.

Will Medicare Pay For Cataract Surgery on Both Eyes?

Yes, so long as your procedure meets the threshold of being medically necessary and is an accepted form of cataract surgery, you’ll be covered by your Medicare benefits. However, having both eyes undergo surgery at once isn’t always recommended.

Under normal circumstances, you can expect at least 4 to 6 weeks of recovery to be necessary following your operation. If you have both eyes done at the same time, you’ll suffer from diminished vision during this time, which is why patients are usually scheduled to undergo their second eye days, if not weeks later, when necessary.

To receive cataract surgery on both eyes, you’ll need them to both be medically necessary, and recovery varies from person to person. This is why the timing of your procedures and the right path to recovery is best left to your team of healthcare providers. However, there are options through Medicare should simultaneous surgery be your best option.

Does Medicare Cover Dropless Cataract Surgery?

Yes, although a new, innovative take on cataract surgery, dropless procedures are covered by your Medicare benefits. This is great news considering the many benefits that come with this procedure, including fewer costs for eye drops, a lower risk of infection and swelling, and making the recovery process much more pleasant.

After your cataract surgery, there are post-operative eye drops that can be necessary for your recovery, but with dropless cataract surgeries, your surgeon will apply antibiotic and anti-inflammatory medication into your eye during your procedure.

Because the medicine is used over a period of weeks, you gain protection during your post-operative recovery period without the need for topical medications. Since this technique is a part of Medicare-approved methods for cataract surgery, you’ll be covered.

Does Medicare Cover Eye Drops for Cataract Surgery?

Original Medicare benefits don’t cover your eye drops following cataract surgery, but coverage options are available. Although Medicare cataract surgery benefits come from Medicare Part B, having your eye drops covered will mean either relying on Part D benefits or a Medicare Advantage prescription plan. If you have Medicare Part D, you’ll want to be sure that the specific eye drops you need to be covered are a part of your plan’s formulary, as each list will vary.

Does Medicare Cover Femtosecond Laser Cataract Surgery?

Yes, because laser cataract surgery covered by Medicare is a benefit provided to you as a beneficiary, you are covered, so long as it is medically necessary. Like LASIK surgery, femtosecond laser-assisted cataract surgery (FLACS) is a technique in which your surgeon will make an incision into your cornea without a blade. They are more accurate than traditional methods and provide a better overall experience for you as a patient.

Does Medicare Cover LASIK Surgery for Cataracts?

Because LASIK surgery isn’t often involved with fixing cataracts for Medicare beneficiaries, you are unlikely to find coverage for this procedure. There are a few reasons why, although exceptions may exist:

• For starters, LASIK surgery is used to reshape your cornea rather than replace your lens, such as traditional cataract surgery.
• LASIK surgery is typically a procedure for younger individuals, whereas cataract surgery patients lean toward an older demographic.
• Furthermore, there are some cases in which both may be necessary, but thanks to advancements in technology for lenses, only cataract surgery is often needed these days.

Ultimately, if LASIK surgery is medically necessary for your cataracts, you should receive coverage from your Medicare benefits. But this seems to be more of a case-by-base situation and is certainly not the norm.

To learn more, you’ll want to consult with your healthcare team to ensure your benefits will cover the procedure beforehand.

Does Medicare Cover Premium Lenses for Cataract Surgery?

While Original Medicare benefits will provide you with coverage for standard frames and corrective lenses following cataract surgery, you won’t be covered for premium eyewear. If you wish to purchase premium eyewear, you can do so out of your own pockets or purchase vision coverage as an ancillary product to help cover the cost.

Medicare Reimbursement Form for Glasses After Cataract Surgery

Billing Medicare for cataract post-op expenses can be a step in the process for some Medicare beneficiaries, particularly those with Medicare Advantage plans. To put things frankly, it’s one of the more complex things you’ll have to take on as a beneficiary and further highlights the benefit of working with a licensed Medicare agent who can be there for you down the line.

You’ll need to submit your Medicare Reimbursement Form for Glasses. But billing Medicare for glasses after cataract surgery requires a variety of qualifying factors that will also affect how much you will receive for your reimbursement, including:

• Whether or not your pair of glasses are premium or not. Medicare benefits don’t cover premium eyeglasses, as mentioned above.
• Your individual types of health insurance.
• Where you live, where you are purchasing your eyewear, and whether or not the provider is in Medicare’s program.
• The price that the store selling you your glasses is selling them for.

Of course, you can only bill Medicare for cataract post-op expenses if your surgery is a qualifying procedure. Depending on the many factors listed above, you may not receive any or your full reimbursement if your purchase does not meet Medicare’s guidelines.

How To Find Medicare Cataract Surgery Coverage

To make sure your benefits provide cataract surgery covered by Medicare coverage, all you have to do is enroll in the Original Medicare program from the federal government, and you’re good to go.

But as you can see above, there are many different scenarios that can affect your healthcare, and Medicare Part A and Part B alone can leave costs that remain. These expenses will require you to cover them if you do not have the proper coverage in place.

Enrolling in Medicare Supplement coverage can help you cover these remaining costs, and for some, Medicare Advantage plans provide valuable benefits. Additionally, Medicare Part D is available for those looking to cut the cost of prescription drugs.

Here at MedicareFAQ, we specialize in helping seniors free of charge find the right coverage for their healthcare and budget needs. This means breaking down your areas of concern, your budget, and the benefits available in your area.

From there, we compare the best coverages available so that you can make an informed decision for your benefits. This means reviewing your options with your present and future needs in mind for a more personalized approach to your healthcare coverage.

Call us at the number above to speak to one of our licensed Medicare agents about coverage of Medicare cataract surgery. If you don’t have time to talk right now, that’s okay! Simply complete one of our online forms to compare coverage options in your area today.

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