Does Medicare Cover Cataract Surgery?

Medicare covers cataract surgery when necessary, but you may still have some out-of-pocket costs.

Janet Berry-Johnson
Janet Berry-Johnson
  • 8+ years writing about insurance, taxes, and personal finance

  • Certified public accountant

Janet applies her experience in personal finance, taxes, and accounting to make complex financial topics accessible. Her byline has appeared on numerous web media.

Featured in

media logomedia logomedia logomedia logo
Ashley Cox
Edited byAshley Cox
Headshot of Managing Editor Ashley Cox
Ashley CoxSenior Managing Editor
  • 7+ years in content creation and management

  • 5+ years in insurance and personal finance content

Ashley is a seasoned personal finance editor who’s produced a variety of digital content, including insurance, credit cards, mortgages, and consumer lending products.

Featured in

media logomedia logomedia logomedia logo

Updated June 27, 2024

Insurify partners with top insurance companies to provide a comprehensive comparison experience. However, the insurance experts writing our content operate independently of our partners. Check out reviews from over 3,000 satisfied customers, how we make money, our data methodology, and our editorial standards.

Cataracts are a condition that causes the lens of your eye to become cloudy, affecting your vision. Cataract surgery, a common procedure to replace your cloudy lens with an artificial lens, can restore your vision.

Medicare generally covers cataract surgery if it’s medically necessary. But you may have some out-of-pocket costs, depending on the surgery type and your healthcare provider.

Learn more about your coverage options and potential expenses to better prepare for the financial aspects of this procedure.

Will Medicare pay for cataract surgery?

Although Medicare doesn’t cover routine eye care, it generally covers the cost of cataract surgery if it’s medically necessary. This means the cataract impairs your vision and affects your daily activities.[1]

To get Medicare to pay for cataract surgery, you need to get a comprehensive eye exam from an ophthalmologist who will determine the severity of the cataract, recommend surgery, and determine the appropriate type of surgery and intraocular lens (IOL) you need.

Cataract surgery with Original Medicare

Original Medicare (Parts A and B) covers cataract surgery when necessary. This includes the surgical procedure itself and any post-operative exams.

Original Medicare covers 80% of the approved cost for cataract surgery after you meet your Part B deductible. You’re responsible for the remaining 20% of the Medicare-approved amount, which can vary depending on your location and the specifics of the surgery.[2]

Good to Know

Your Medicare Part B coverage also pays for one pair of eyeglasses with standard frames or one set of contact lenses after each cataract surgery that implants an IOL.

Cataract surgery with a Medicare Advantage plan

A Medicare Advantage plan (Part C) will cover cataract surgery, as these plans must provide at least the same benefits as Original Medicare.[3] But your plan may have different copays, co-insurance percentages, and coverage rules. Contact your plan provider to learn about how your plan covers cataract surgery.

When Medicare might not pay for cataract surgery

Medicare covers cataract surgery using traditional surgical techniques or lasers, but it might not cover all cataract procedures. Medicare might not cover your surgery when:

  • You choose a special type of IOL. Your ophthalmologist might recommend one of several types of lenses for your cataract surgery. Medicare covers the most common IOL, the mono-focal lens, designed to provide the best possible vision at one distance. Medicare might not cover other more advanced implants.[4]

  • You choose to have surgery before your vision deteriorates. A refractive lens change is an elective surgery that replaces your eye’s natural lens with an IOL to improve your vision and avoid developing cataracts later in life.[5] Since Medicare only covers medically necessary cataract surgery, it won’t cover elective surgery to correct your vision.

Read More: Best Medicare Advantage Plans

Read More: Best Medicare Advantage Plans

How much Medicare pays for cataract surgery

When your doctor deems cataract surgery medically necessary, Medicare Part B (medical insurance) pays 80% of the Medicare-approved cost for the surgery after you meet your annual Part B deductible, which is $240 in 2024.[6]

How much Medicare actually pays depends on whether you have the procedure done at your doctor’s office or a hospital.

The federal government pays an average of $1,525 for cataract surgery performed at a surgical center or doctor’s office and $2,355 at a hospital outpatient department, according to Medicare.gov’s procedure-price lookup tool.

Out-of-pocket costs for cataract surgery with Medicare

As with any other health insurance policy, Medicare doesn’t cover 100% of your costs. Depending on whether you have Original Medicare or a Medicare Advantage plan, these are some out-of-pocket costs you’ll have to pay for cataract surgery:

  • illustration card https://a.storyblok.com/f/162273/150x150/1d8803fded/credit-and-loan-96x96-blue_019-calendar.svg

    Deductible

    The Medicare Part B annual deductible is $250 in 2024. You must pay this amount toward your healthcare costs before Medicare starts to pay.

  • illustration card https://a.storyblok.com/f/162273/150x150/42a396bd18/credit-and-loan-96x96-green_033-discount.svg

    Co-insurance

    Under Original Medicare, you must pay 20% of the cost of any Medicare-covered service or item after you pay your deductible.[7]

  • illustration card https://a.storyblok.com/f/162273/150x150/1f77dd73f2/money-96x96-orange_042-invoice.svg

    Copay

    If you have a Medicare Advantage plan, you may need to pay a copay for services instead of co-insurance. A copay is a fixed amount you pay for a specific service. The amounts vary depending on the plan and type of service.

Medicare.gov’s procedure-price lookup tool provides the following average costs to help you estimate your out-of-pocket costs for cataract surgery:

 Cost at Doctor’s Office or Surgical CenterCost at Hospital Outpatient Department
Doctor fee$723$723
Facility fee$1,183$2,220
Total cost$1,906$2,943
Medicare pays$1,525$2,355
Patient pays$380$588

Parts of Medicare that cover cataract surgery

Multiple parts of Medicare can cover the cost of cataract surgery.

What Part A covers

Medicare Part A (hospital insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home healthcare.

Typically, your Medicare Part A coverage won’t come into play for cataract surgery because it’s an outpatient procedure. But your Part A coverage may apply if you have complications and need to be hospitalized.

What Part B covers

Medicare Part B (medical insurance) covers doctor’s visits, outpatient care, medical supplies, and preventative services. Part B typically applies to cataract surgery, including your initial exam, surgery, new lenses, and follow-up care.

Cataract surgery with Medicare Part C

Medicare Part C is an alternative to Original Medicare that includes Parts A and B plus additional benefits like vision, dental, and prescription drug coverage.

Medicare Part C plans must cover the same services as Original Medicare, so they cover cataract surgery. But your plan may have more expansive coverage and different deductibles, copay, and co-insurance amounts.

For example, while Original Medicare covers 80% of the cost of cataract surgery, your Medicare Part C plan may cover the total cost after your deductible.

Medicare Part D coverages for cataract surgery

Medicare Part D helps cover the cost of prescription drugs. It’s not included in Original Medicare, but you can generally purchase Part D separately or as part of a Medicare Advantage plan.

Part D doesn’t cover cataract surgery, but it can cover the cost of prescription medications before or after surgery, such as eye drops to prevent infections and reduce swelling.

Medigap coverages for cataract surgery

Medigap, also known as Medicare supplemental insurance, is extra insurance you can buy from a private health insurance company to help pay for your out-of-pocket costs in Original Medicare.

If you have a Medigap policy, it can help cover the deductible, copay, or co-insurance associated with your cataract surgery.[8]

See Also: 5 of the Best Sites to Compare Medicare

See Also: 5 of the Best Sites to Compare Medicare

Cost of cataract surgery without Medicare insurance

If you don’t yet qualify for Medicare and don’t have other health insurance to cover cataract surgery, you’ll have to come up with another way to cover the costs.

The cost of standard cataract surgery can vary widely depending on your location, facility type, surgical procedure, and the intraocular lens used.

In the U.S., cataract surgery costs an average of $3,500 for each eye but could be up to $7,000 per eye if you live in a high-cost-of-living area, get laser-guided surgery, or choose a more advanced lens.

Medicare and cataract surgery FAQs

Here’s some additional information about Medicare for cataract surgery to help you navigate your options.

  • Does Medicare cover cataract surgery 100%?

    Not usually. Original Medicare covers 80% of the Medicare-approved cataract surgery cost after paying your Part B deductible. If you have a Medicare Advantage plan or Medigap, it may cover more of those costs.

  • Can you get free glasses after cataract surgery with Medicare?

    Medicare Part B covers one pair of eyeglasses with standard frames or corrective lenses after each cataract surgery that implants an intraocular lens. But your normal deductible, co-insurance, or copay still applies.

  • How much does cataract surgery cost without insurance?

    In the U.S., cataract surgery averages $3,500 per eye. But your costs may be higher depending on your location, the type of lens you and your doctor select, and whether you get the surgery in your doctor’s office or a hospital.

  • What’s the best Medicare plan for cataract surgery?

    The best Medicare coverage for cataract surgery depends on your specific needs. Original Medicare Part B covers cataract surgery, but combining Medicare with a Medigap plan can cover more out-of-pocket expenses. A Medicare Advantage plan may offer additional benefits but may have network restrictions and varying additional costs.

Sources

  1. American Academy of Ophthalmology. "Cataract Surgery: Risks, Recovery, Costs."
  2. Medicare.gov. "Cataract surgery."
  3. Medicare.gov. "Understanding Medicare Advantage Plans."
  4. American Academy of Ophthalmology. "Factors to Consider in Choosing an IOL for Cataract Surgery."
  5. Cleveland Clinic. "Refractive Lens Exchange."
  6. Centers for Medicare & Medicaid Services. "2024 Medicare Parts A & B Premiums and Deductibles."
  7. Medicare.gov. "Costs."
  8. Medicare.gov. "Learn what Medigap Covers."
Janet Berry-Johnson
Janet Berry-Johnson

Janet Berry-Johnson, CPA is a freelance writer with a background in accounting and income tax planning and preparation. She's passionate about making complicated financial topics accessible to readers. She lives in Omaha, Nebraska with her husband and son and their rescue dog, Dexter. Visit her website at www.jberryjohnson.com.

Ashley Cox
Edited byAshley CoxSenior Managing Editor
Headshot of Managing Editor Ashley Cox
Ashley CoxSenior Managing Editor
  • 7+ years in content creation and management

  • 5+ years in insurance and personal finance content

Ashley is a seasoned personal finance editor who’s produced a variety of digital content, including insurance, credit cards, mortgages, and consumer lending products.

Featured in

media logomedia logomedia logomedia logo

Latest Articles

View all