Although Original Medicare doesn’t cover routine vision care, it does help pay for cataract surgery if it’s done using traditional surgical techniques or lasers.1 This is through Medicare Part B, the medical insurance portion of Original Medicare. Let’s explore cataract surgery and Medicare, including costs, eligibility and coverage details.
A cataract is a cloudy area in the lens of the eye that can make vision blurry. Most cataracts develop as people age but cataracts can also occur from an eye injury or previous eye surgery.2
Cataracts are common as well. More than 50% of Americans aged 80 or older have cataracts or have had cataract surgery to get rid of them.3 Cataract surgery corrects vision problems caused by cataracts and is 1 of the most common, safe, and effective types of surgery done in the United States.4
Without private insurance or Medicare, the out-of-pocket expense for cataract surgery can range from $3,000 to $6,000 per eye.5 Specific costs can vary depending on your surgeon, surgical technique and other fees. Some surgeons may offer payment plans to help split up the payments and you may be able to use a health savings account (HSA) to pay the cost as well.
Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees.
Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). Your Part B benefits may also pay for 1 pair of prescription eyeglasses with standard frames or a set of contact lenses.
Factors that can affect the cost of cataract surgery with Medicare include:
- your current Medicare Advantage plan
- type of surgery needed
- how long the surgery takes
- where you have the surgery (clinic or hospital)
- other medical conditions you have
- potential complications
If the cataract surgery takes place in an outpatient facility, Medicare Part B will help cover the costs. If the surgery requires hospitalization, Medicare Part A (Hospital Insurance) may pay some of the costs.
Medicare Supplement (Medigap) plans
Medicare Supplement insurance plans, also known as Medigap, can help pay some of the healthcare costs that Original Medicare doesn’t pay, like copayments, coinsurance and deductibles. Some Medigap plans may cover the Part B copayment, which means if you’ve met your deductible, you may not pay anything for presurgical appointments, the surgery, follow-up care and 1 pair of corrective lenses.
Medicare Advantage (MA) plans
Medicare Advantage plans, sometimes called Part C or MA plans, offer complete Part A and Part B coverage and other potential benefits, like vision services. If you have an MA plan and get cataract surgery with a provider in the plan’s network, you may be able to save on out-of-pocket costs.
To see if your Medicare Advantage plan will cover for cataract surgery, you can:
- Read the Summary of Benefits and Coverage that you received when you enrolled in your plan. You should be able to find information stating if cataract surgery is covered.
- Contact your Medicare Advantage plan provider. They should be able to give you a clear answer about your plan and cataract surgery.
If you have a Humana Medicare Advantage plan and need to check if your plan covers cataract surgery, call 800-457-4708 (TTY: 711), 8 a.m. – 8 p.m., Eastern time, Monday through Friday.