Does Medicare Cover Cataract Surgery?

Yes, Medicare covers the majority of cataract surgery if it is deemed medically necessary. Medicare Part B covers 80 percent of the cost after the deductible is met. 

Since Medicare Advantage plans cover the same services as Original Medicare, they will also cover cataract surgery. Exact coverage under a Medicare Advantage plan will depend on the specific plan you have.

Cost of Cataract Surgery Without Insurance

The average cost of cataract surgery in the United States is between $3,500 and $7,000 per eye. 

Price variations may be due to various factors, such as these:

• Regional variations
• The type of lens implanted during the procedure
• Surgeon expertise
• The severity of your cataract
• Whether it’s an outpatient or hospital procedure
• Testing, exams, and medications
• Extent of aftercare

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What Is the Cost of Cataract Surgery With Medicare? 

Typically, Medicare covers 80 percent of expenses for cataract surgery procedures and related expenses. These services include cataract removal, lens implants, and one set of eyeglasses or contacts following surgery. 

If the cost of cataract surgery is $4,300, Medicare would pay about $3,440. You’d be responsible for the remaining amount. Also, you must first meet your annual deductible before your coverage kicks in.

Keep in mind that there may be additional costs that are not covered, such as if you opt for premium lenses. Medicare will usually cover monofocal IOLs, but you will have to pay the difference between the cost of these and premium lenses.

Confirm the total cost with your surgeon ahead of time, so you have a clear idea of exactly what you can expect to pay out of pocket. 

Exclusions

Generally, Medicare covers the most common procedures. For cataract surgery, this involves using a monofocal lens. If you opt for a premium lens, such as a lens that can correct vision at multiple points, you will have to pay the difference out of pocket.

These types of lenses are not covered by Medicare:

• Multifocal lenses
• Accommodative lenses
• Toric lenses

Medicare will pay for cataract surgery when it is identified as medically necessary. 

To avoid any misunderstanding or unexpected financial burden, check with your doctor to make sure that your surgery is considered medically necessary. If it is not, you have to pay for it all out of pocket.

Which Parts of Medicare Cover Cataract Surgery?

The total cost of cataract surgery involves the surgery, follow-up exams, eye care, and prescriptions. 

Be aware that some of the plans, like Medicare Advantage plans, are via private insurers, so check with your provider regarding coverage. 

Medicare Part A

This is part of Original Medicare and covers in-hospital costs. Since cataract surgery is often performed in clinics and outpatient settings, this part of Medicare may not apply.

If your surgery is done in a hospital, Medicare Part A may apply. Your coverage will be subject to meeting your deductible. In 2022, the deductible for Part A is $1,556.

Medicare Part B

Part B covers outpatient care. Since cataract surgery is most often done on an outpatient basis, it is most often covered by Medicare Part B. This includes coverage for the lens implant, surgical removal of the cataract, and prescription glasses or contacts following the procedure.

Under this portion of Medicare, about 80 percent of the total cost of cataract surgery will be covered. You will need to cover the remaining 20 percent out of pocket once you’ve met your annual deductible. In 2022, the deductible for Medicare Part B is $233.

Medicare Part C

This is commonly called Medicare Advantage, and it enables individuals to get Medicare benefits via a private insurer. These plans vary widely.

All Medicare Advantage plans provide at least the level of coverage offered in Original Medicare. Some Part C plans may provide additional benefits.

Check with your private insurance company for details and to verify your coverage. In some cases, you may not have any out-of-pocket costs for cataract surgery.

Medicare Part D

Part D covers prescription drugs. It’s possible that you won’t need medications for your procedure, but if you do, this is the portion that could cover the costs.

Check with your doctor regarding any prescription drugs they recommend before or after surgery..

Know Your Costs Before Surgery

Confirm all costs with your surgeon and your insurance provider prior to surgery. You can contact Medicare directly for information on the specifics of your coverage, particularly if you have a Medicare Advantage plan. 

Ask to have all out-of-pocket costs detailed, so you know exactly what to expect going into surgery.

Factors That Affect How Much You Pay

Several factors affect how much you pay for cataract surgery.

Some regions of the U.S. are simply more expensive, and this higher pricing extends to surgery. Confirm that the amount you’re paying is consistent with other surgeons in the area. 

Different offices offer different levels of aftercare. If your doctor provides extensive follow-up care, this may increase the overall cost of the surgery. 

Likewise, technology will affect the final cost. Laser-assisted cataract surgery is typically more expensive than traditional surgery. 

The Bottom Line

With Medicare, you can expect to pay much less out of pocket for cataract surgery. Medicare Part B and Medicare Advantage Plans cover the cost of cataract surgery, but you can expect to pay out of pocket if you opt for premium lenses. 

Cataract Surgery Cost FAQs

Does Medicare pay for cataract surgery in 2022?

Medicare Part B covers cataract surgery with placement of monofocal lenses.

Does Medicare cover all of the cost of cataract surgery?

No, Medicare covers 80 percent of the cost of cataract surgery, which includes exams, standard surgery, and one set of eyeglasses or contacts following surgery.

What percentage of cataract surgery does Medicare cover?

Medicare covers 80 percent of the cost of cataract surgery. You can expect to pay 20 percent once you’ve met your deductible.

How do Medicare deductibles work for cataract surgery?

A deductible is a payment you pay out of pocket before Medicare begins covering your costs. Insurance experts explain that deductibles are different for different parts of Medicare. 

For instance, if you received an outpatient cataract surgery covered by Part B, you would first pay a deductible of $233. This payment covers the deductible. 

You will usually pay 20 percent of the cost of procedures covered by Medicare. Medicare would cover 80 percent of the remaining costs.

For 2022, the Medicare Part A deductible covers certain hospitalization costs and works a little differently. The deductible is $1,556 for each benefit period. A benefit period starts the day you enter the hospital and ends after you have not needed inpatient care for 60 consecutive days. If your cataract surgery is done in a hospital, you may be using Medicare Part A to cover expenses. 

If you re-enter a hospital after the benefit period ends, $1,556 applies as a new deductible.

Does insurance cover premium IOLs for cataract surgery?

Medicare covers monofocal lens placement during cataract surgery. Premium IOLs, such as multifocal and accommodative lenses, are not covered. 

The same is usually true of private insurance. If you want a premium lens, you will generally have to pay the cost difference yourself. 

Talk to your insurance provider or your Medicare representative to understand the specifics of your plan.

References

1. Medicare Vision Services. (August 2021). Centers for Medicare & Medicaid Services (CMS).

2. Healthcare Bluebook. Healthcare Bluebook.

3. Medically Necessary. Medicare Glossary. Medicare.gov.

4. 2022 Medicare Costs. (November 2021). Medicare.gov.

5. Part B Costs. Medicare.gov.

6. Routine Eye Exam Coverage. Medicare.

7. Does Medicare Cover Cataract Surgery? Aging in Place.

8. Vision Health Frequently Asked Questions. Centers for Disease Control (CDC).

9. Femtosecond Laser–Assisted Cataract Surgery Compared With Phacoemulsification Cataract Surgery: Randomized Noninferiority Trial With 1-Year Outcomes. (October 2020). Journal of Cataract & Refractive Surgery.