Does Medicare Cover Cataract Surgery?

November 10th, 2023

Congratulations on your decision to move forward with cataract surgery! Now that you’re ready to take this important step to restore your vision, you may be wondering about your payment options. At Swagel Wootton Eye Institute, we do everything we can to make cataract surgery affordable for everyone. The cost of cataract surgery varies based on several factors, including insurance plan coverage, deductibles, and copays. Without insurance, it can cost several thousand dollars for each eye. Fortunately for many patients, Medicare insurance covers much of the cost. Here’s what you need to know.

Surgery Must Be Medically Necessary

Cataract surgery must be deemed medically necessary to be covered by insurance. This means that the cataract must impair your vision to a significant extent, to the point where other less-invasive treatments, such as corrective lenses, are not effective. Additionally, vision acuity must meet a certain threshold, and your daily activities must be severely impacted.

You Must Have Original Medicare Part B

Medicare Part B (the medical insurance part of Original Medicare) covers 80% of Medicare-approved costs for traditional cataract surgery or laser cataract surgery after the Part B deductible is met. That means you will be responsible for 20% of the cost. Medicare supplement plans, also called Medigap plans, may help cover those costs if you’ve purchased this type of plan.

Medicare Advantage Plans May Cover Cataract Surgery

Medicare Advantage plans, also called Part C or MA plans, are purchased through private insurance companies. Many plans will cover the full cost of cataract surgery, but coverage depends on the plan. You may also be responsible for copays and coinsurance. Importantly, your provider and facility must be in the plan’s network. Always speak to your insurance provider prior to your surgery to understand your plan benefits and out-of-pocket payment responsibilities.

You May Be Responsible for Premium Lenses

During cataract surgery, your eye’s natural lens is replaced with an artificial one called an intraocular lens (IOL). There are several IOL options available to help meet your vision goals. Medicare only covers standard, monofocal IOLs. Premium IOLs include toric IOLs, which help correct astigmatism, and multifocal IOLs, which enable you to see at different distances. These premium IOLs often require an out-of-pocket cost.

Medicare Part B Covers Eyeglasses After Surgery

Medicare typically doesn’t cover eyeglasses or contact lenses; however, Medicare Part B will cover corrective lenses after cataract surgery in which an IOL is implanted. Coverage includes one pair of eyeglasses with standard frames or one set of contact lenses.

Affordable Payment Options for the Vision You Deserve

At Swagel Wootton Eye Institute, we’re proud to accept a wide range of vision and insurance plans, and our patient care team is always happy to help verify your insurance coverage.

If you do not have insurance, or if your plan will not cover your cataract surgery, we can help you explore other ways to pay for your procedure. We accept health savings accounts and flexible spending accounts, and we offer convenient financing options.

We’re Invested In You

The board-certified cataract surgeons at Swagel Wootton Eye Institute have decades of combined experience and have helped thousands of patients improve their quality of life. We invest in advanced cataract surgery technologies, including the latest cataract lens implants, to ensure patient safety, comfort, and optimal outcomes. Request an appointment with us today.