Does Medicare Cover Laser Cataract Surgery? 

Cataracts are a common vision concern for seniors. Cataracts tend to begin developing in the late stages of middle age. By the time someone has reached retirement age and is eligible for Medicare benefits, the odds of developing cataracts rise dramatically. The cause of cataract development is the breakdown of proteins in the eye.

As this breakdown occurs, the lens of the eyeball begins to develop a cloudy film that can obscure vision. Someone suffering from cataracts may not notice any changes in vision at first, but over time, sight may diminish and become darkened or blurry. If left untreated, cataracts do have the potential to lead to total blindness.

How Are cataracts treated?

Cataract treatment is usually handled through laser removal surgery. During this procedure, a specialized laser is used to make fine, minute cuts to remove the affected lens from the eyeball. Afterward, an artificial lens is fitted to the eye to restore vision. The recovery process can require the use of corrective lenses for a temporary period of time, but once the affected area has completely healed, many seniors will not need to continue wearing glasses.

How does Medicare cover laser cataract surgery?

Medicare is limited in what it covers in terms of vision care, but Medicare benefits are applicable to laser cataract surgery. In order to use Medicare benefits to pay for cataract surgery, the procedure will need to be ordered by a Medicare-participating physician or specialist. Medicare Part B supplies benefits for laser cataract surgery since the procedure is handled on an outpatient basis.

Medicare recipients who want to utilize Part B benefits will need to sign up for this coverage during the Initial Enrollment Period or during an Open Enrollment Period. Medicare Part B requires a monthly premium payment in order to remain active. A deductible also applies before Medicare benefits can be used to pay for outpatient services.

If laser cataract surgery is provided while you are hospitalized or while you are admitted to a skilled nursing facility (SNF), Medicare Part A provides benefits instead. This is inpatient or hospital insurance. Part A covers services provided while admitted to a Medicare-participating hospital or skilled nursing home for a limited amount of time each benefit period.

Does Medicare cover routine vision care?

Although Medicare insurance covers laser cataract surgery, Medicare coverage is not available for routine vision care. This means that eye exams outside of your doctor’s office are not covered by Medicare. Corrective lenses outside of one temporary pair following cataract surgery are not covered either.

You may, however, be able to obtain vision care benefits by enrolling in a Medicare Advantage plan. These plans offer the same benefits as Original Medicare. They can also include additional benefits that are not covered by Part A and B, such as Part D prescription drug coverage, vision and dental care, gym memberships, and more. 

Medicare Advantage plan providers often include additional benefits in their plan offerings, but what is available to you may be limited by your state and the providers in your area. To learn more about obtaining vision care benefits through a Medicare Advantage plan, consider working with an independent Medicare insurance broker who can shop plans from a variety of providers to help you find the right solution for your unique healthcare needs.