Does Medicare Cover Cataract Surgery?

Developing cataracts is an inevitable part of the aging process. Eventually, more than half of our population will be afflicted with cataracts, typically starting around age 60. This condition causes cloudy or blurry vision. The only way to correct this is through surgery.

Fortunately, Medicare provides coverage for cataract surgery deemed medically necessary. Cataract surgery encompasses removing the cataract and inserting a standard intraocular lens (IOL). An IOL is a small, lightweight, clear disk that replaces the focusing power of the eye’s natural crystalline lens to restore clear vision. This procedure is performed using traditional surgical techniques or lasers. Medicare coverage can provide substantial savings, since cataract surgery often costs between $3,000 to $5,000 per eye.

Cataract surgery is usually an outpatient procedure, covered under Medicare Part B. After paying the annual Part B deductible of $240 in 2024, you will be responsible for the Part B coinsurance. This coinsurance amounts to 20% of the cost for covered services. If you have a Medicare supplemental policy, or Medigap, you will have full or partial coverage for the 20% Part B coinsurance.

If you are enrolled in a private Medicare Advantage Plan, you also have coverage for cataract surgery. Under these plans, you may have to pay different deductibles or copayments and use an in-network provider. You should call your plan to find out its coverage details before you schedule surgery.

What Is Not Covered

Keep in mind that Medicare only covers cataract surgery with standard (monofocal) intraocular lenses, which improves vision at just one distance so you may still need glasses for close-up vision. Medicare will not cover premium (multifocal) intraocular lenses that can correct vision at multiple distances allowing you to no longer require glasses after surgery.

Premium interocular lenses are expensive, costing approximately $1,500 to $4,000 per eye, which you would be responsible for if you choose to upgrade. Speak with your doctor about your options and costs before you schedule your surgery.

Are Eyeglasses Covered?

While Medicare typically does not provide coverage for eyeglasses or contact lenses, it will reimburse 80% of the cost for a single pair of corrective glasses or contacts after cataract surgery. Medicare, however, limits its coverage to standard eyeglass frames and lenses. If you want deluxe frames, progressive or tinted lenses or scratch-resistant coating for glasses, you will need to pay those costs yourself. Medicare also requires that you purchase the glasses or contacts from a Medicare-approved supplier.

If you experience post-surgery complications or problems that are deemed medically necessary, your expenses will be covered by Medicare. Any eyedrops, antibiotics or other medication prescribed after your surgery would also be covered by Medicare Part D or a Medicare Advantage Plan that includes prescription drug coverage.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.