By age 65, over 90 percent of people have a cataract and half of the people between the ages of 75 and 85 have lost some vision due to a cataract. So, does Medicare cover cataract surgery? Let’s find out.
What is Cataract Surgery?
Cataract causes the lens of your eyes to become cloudy and increases the glare from the light which will affect your vision and can make it difficult to carry out day-to-day activities.
Cataract surgery is a procedure to remove the lens of your eye and replace it with an artificial lens called an intraocular lens (IOL).
Cataract surgery is a common eye procedure and generally considered a safe procedure.
Does Medicare cover Cataract Surgery?
Both Medicare Part B (Medical Insurance) and Part A (Hospital Insurance) will help cover costs related to cataract surgery. Medicare covers cataract surgery if it’s done using traditional surgical techniques or using lasers.
This procedure is typically performed in an outpatient setting, does not usually require hospitalization, and is therefore covered under Medicare Part B. However, if the surgery requires hospitalization, Part A will cover the costs related to inpatient costs.
While Medicare will help cover the cost of cataract surgery, under Medicare Part B, you will be responsible for 20% of the approved amount for the services delivered by your ophthalmologist (eye doctor). If you have not yet reached your Medicare Part B deductible for the year you will also need to cover this out-of-pocket cost before Medicare Part B kicks in.
Typically Part B coverage includes:
- Removal of the cataract
- Lens insertion and required supplies and services, however, Medicare only pays for the cost of inserting basic (monofocal) lenses, although advanced lenses may be available
- A pair of eyeglasses with basic frames or contact lenses after each cataract surgery
Based on most recent estimates, the average gross cost of cataract surgery is $3,500 per eye (excluding Medicare coverage) but this will ultimately vary depending on your specific situation and provider.
Does Medicare Advantage cover Cataract Surgery?
Medicare Advantage plans (also known as Part C coverage) are health insurance plans provided by private health insurance companies. Medicare Advantage plans are required to provide the same coverage on services as Original Medicare, so Part C coverage will also cover your cataract surgery.
Medicare Part C also has extra benefits like coverage for vision, hearing, and dental. This means that your glasses and contact lenses can potentially be fully covered depending on your plan.
Does Medigap cover Cataract Surgery?
Medigap will cover the cataract surgery. Medigap plans are supplemental insurance plans provided by private insurance companies to help cover out-of-pocket costs in Original Medicare in return for an additional monthly premium.
As cataract surgery is covered under Original Medicare, Medigap will help cover the out-of-pocket costs related to the Medicare qualified services and supplies in line with the policy’s stated benefits (which will differ depending on the type of Medigap plan you have purchased).