Does Medicare Cover Cataract Surgery? – Forbes Health

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Yes. Original Medicare and Medicare Advantage cover cataract surgery, which is notable because Medicare does not cover routine eye exams. For surgery to be covered, it must be performed using traditional surgical techniques or lasers.

Original Medicare covers 80% of the cost of cataract surgery, says Cameron E. Herrin, an optometrist who practices in Oklahoma, Texas and Hawaii. The patient is responsible for paying the remaining 20%, either out of pocket or with additional insurance (often called Medigap) if you have purchased such a plan, Herrin explains.

Many Medicare Advantage plans cover the full cost of cataract surgery. “However, many doctors, hospitals, and surgery centers are not under contract with many Advantage plans,” Herrin explains, making it important to verify that your insurance will be accepted before scheduling the procedure. Meanwhile, almost all doctors and hospitals are under contract with Original Medicare, Herrin adds.

What does Medicare coverage for cataract surgery include?

Original Medicare covers:

  • An intraocular lens (IOL), which is a small, light disc that replaces the natural lens of the eye affected by cataracts.
  • Installation and physician services during surgery.
  • A pair of prosthetic glasses or contact lenses.

How much does cataract surgery cost with Medicare?

According to Medicare.gov, having cataract surgery at an outpatient surgery center costs about $ 1,789 ($ 750 in physician fees and $ 1,039 in facility fees). Medicare pays $ 1,431 of this total, which means the patient pays $ 357. (Outpatient surgery centers are non-hospital facilities for patients who do not require more than 24 hours of care.)

In contrast, having cataract surgery in a hospital’s outpatient department costs $ 2,829 ($ 750 in physician fees and $ 2,079 in facility fees). Medicare pays $ 2,263 of this total, so the patient pays $ 565. These estimates vary depending on where you live and the complexity of your cataracts.

The cost of cataract surgery with Medicare Advantage varies widely depending on your specific plan. Contact a customer service representative with your provider to discuss what you can expect to pay before undergoing the procedure.


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