While Medicare doesn’t cover routine vision screening, it does cover cataract surgery.
Since cataract surgery is typically performed on an outpatient basis, it’s usually covered under your Medicare Part B benefits. However, Medicare Part A may cover emergency services in a hospital.
Usually, Medicare pays 80% of the total surgical cost, consisting of surgical and facility charges, as long as a doctor has deemed it medically necessary.
Medicare Part D, which is the prescription drug plan, may cover the prescription medications you need after you have had your cataract surgery.
Usually, Medicare does not cover prescription eyeglasses. The exception is one pair of spectacles after cataract surgery.
What Type of Cataract Surgery Does Medicare Cover?
Medicare covers two types of surgery: manual blade surgery and laser surgery.
Medicare will also pay for an intraocular lens (IOL), which corrects presbyopia or astigmatism, but only if these lenses should be replaced because of cataracts. However, Medicare may not cover all types of IOL. It does pay for monofocal lenses, which a surgeon will typically use during cataract surgery.
Although other lenses are available, including multifocal and toric lenses, Medicare may not cover these. They will also not pay for procedures exclusive to the implantation of these more advanced lenses that a surgeon would not perform for a traditional monofocal lens.
How Much Does Medicare Cataract Surgery Cost With No Extra Coverage?
According to a report prepared for All About Vision by leading eye care industry analytics firm Market Scope, the general cost of cataract surgery in one eye with no insurance has ranged from approximately $3,783 to $6,898 per eye in 2019. Medicare Part B covers 80% of standard surgery once you meet your annual deductible.
For example, say you need cataract surgery on one eye, and it costs $5,000 for the standard procedure. You would need to pay 20% after you meet your deductible. (The 2021 Part B deductible is $203). We'll break down the example below:
Cataract Surgery | Medicare Coverage | Out-of-Pocket | Deductible | Cost to you |
|---|---|---|---|---|
$5,000 | $4,000 | $1,000 | $203 | $1,208 |
You may be able to get even more coverage through a Medicare Supplement plan (Medigap) or Medicare Advantage plan.
The role of Medicare supplemental plans with Cataracts
Medicare supplemental plans, also known as Medigap, are private insurance policies that help people pay the 20% of costs excluded from Medicare coverage.
For instance, supplemental plans may pay deductibles, copayments, and other out-of-pocket expenses - leaving you with little to no out of pocket expenses for your cataract surgery. Any person aged 65 years or older with Medicare parts A and B can apply for a supplemental plan.
The role of Medicare Advantage plans with Cataracts
A Medicare Advantage plan is a private insurance plan that replaces your Medicare Part A and Part B benefits. Some Medicare Advantage plans offer additional routine vision benefits, but at the very least all of these plans must cover services that are equal to Medicare Parts A and B.
Your share of the cost will depend on your plan, but your contribution never exceeds your out-of-pocket maximum. Refer to your annual Summary of Benefits and Coverage to see your plan’s particulars.
Are you interested in learning about available plans in your area? Click the button below to request a no-cost, no obligation appointment with a licensed agent.
