Does Medicare Cover Cataract Surgery?
- Does Medicare Cover Cataract Surgery?
- What is a Cataract?
- What is Cataract Surgery?
- Why Would You Have Cataract Surgery?
- How Much Does Cataract Surgery Cost on Medicare?
- Are Eyeglasses Covered by Medicare with Cataract Surgery?
Yes, Medicare covers cataract surgery.
Medicare Part B covers the costs associated with cataract surgery. This includes if you need corrective lenses as a result from surgery. (Such as glasses or contact lenses.)
Let’s get into the necessary details you will want to know before cataract surgery. (Such as, how much will I pay?) But first, what is a Cataract? And second, why would you need cataract surgery?
What is a Cataract?
According to the National Health Institute:
- Cataracts are a cloudy area in the eye’s lens that affects vision.
- To start, cataracts are a very common eye problem in older people.
“When you’re young, the lens in your eye is clear. Around age 40, the proteins in the lens of your eye start to break down and clump together. This clump makes a cloudy area on your lens — or a cataract. Over time, the cataract gets more severe and clouds more of the lens.”National Health Institute
- Interestingly, over half of Americans over the age of 80 have either had cataracts (and just lived with them) or have had surgery to remove them.
- According to the Center for Medicare and Medicaid Services, cataract risk increases not only with age, but with long -term exposure to sunlight, diabetes, and smoking. In addition to using some medications, drinking too much, or having a family history of cataracts.
What is Cataract Surgery?
Cataract surgery is the removal of your cloudy eye lens, and then the replacement of your original lens with a new, artificial lens. It is done in an outpatient setting in a hospital or an ambulatory surgical center. This means, you are in and out without an overnight hospital stay.
Why Would You Have Cataract Surgery?
Some people’s cataracts do not bother them enough to do anything about them. If you are trying to stave off surgery, you can try
- getting stronger glasses,
- or a magnifying device or lenses,
- reducing glare with your glasses or sunglasses,
- or just increasing the amount of light in your living areas.
However, if it gets to the point where you are having trouble seeing, you may need surgery. According to the National Health Institute, people who have cataracts may notice:
- Blurry Vision
- Hazy/Halo Vision
- Seeing Dulled Colors
- Trouble Reading
- Poor Night Vision
- Seeing Double
Some people just get cataracts naturally with age. While others will develop them after another eye surgery, eye trauma or glaucoma issues. Source NHI.
How Much Does Cataract Surgery Cost on Medicare?
The CMS Medicare.gov website has a “Procedure Price Lookup” page where you can see the average costs of medical procedures.
Remember, this is not an exact price of what you will pay. It is just an estimate, but it can be very helpful. (Your actual costs will depend on if you have extra insurance, what your doctor charges, any facility charges, where you live, and any other variable medical costs involved with your care.)
How to Look Up Your Cost Estimate on Medicare.gov
If you want to know how much Cataract Surgery costs on average, you can visit their website. Then, type in “Complex removal of cataract with insertion of lens.” (This is under code: 66982.)
When we looked up this procedure at the end of 2020, the average cost was:
- Ambulatory Surgical Centers Total Cost of $1,777
- Patient Pays $355
- Medicare Pays $1,422
- Hospital Outpatient Surgery Total Cost of $2,786
- Patient Pays $557
- Medicare Pays $2,229
Here is a screenshot from the date we looked it up. (However, prices change, so please use the tool for an up to date estimate.)
- This is providing you with an estimate of what Original Medicare will pay for.
- However, you most likely have additional insurance in the form of a Medicare Supplement (Medigap) Plan or from a Medicare Advantage Plan.
How Much Does Cataract Surgery Cost with Medigap?
Depending on what Medigap Plan you have, you may have all the extra costs covered through your supplement. (However, some plans have you pay the Medicare Part B Deductible. Please read this article to understand what Supplements cover what costs.)
How Much Does Cataract Surgery Cost with Medicare Advantage?
If you have a Medicare Advantage Plan, you most likely will have a co-pay, deductible or coinsurance. You can read more about Medicare Advantage Plan costs here.
Are Eyeglasses Covered by Medicare with Cataract Surgery?
According to Medicare.gov, the only time that Medicare covers eyeglasses or contact lenses is if you need them after cataract surgery for corrective purposes. In this case, you would still be responsible for 20% of the cost.
In addition, the corrective lenses would be under Medicare Part B, so the Part B Deductible would also apply. This is unless you have supplemental coverage (for example, Medigap or Medicare Advantage).
Does Medicare Cover Eyeglasses or Contacts in General?
Typically, Original Medicare will not cover contact lenses or eyeglasses outside of cataract surgery. However, there are Medicare Advantage Plans that have an eyeglass or contact benefit included. The amount varies from plan to plan and from year to year. These are outside of, or in addition to, cataract surgery corrective lenses needs.
Cataract surgery is covered by Medicare Part B. If you are considering cataract surgery, the first thing to do is to talk with your medical providers.
Then, consult with your insurance provider’s information or personnel on cost. Ask them what your financial responsibility is for the costs Original Medicare Part B does not cover (the 20% coinsurance).
Depending on what kind of plan you have, you may be responsible for all, some, or none of the co-insurance costs.
This information isn’t intended to replace professional medical advice, diagnosis, or treatment.