Does Medicare Cover Cataracts? 

More than 20 million people in the United States are affected by cataracts. This common medical condition causes the lens of the eye to become cloudy, making it more difficult to see clearly and participate in simple daily activities.  

Cataracts can become a result of age, an eye injury, heredity, diabetes or other health issues, or because of long-term steroid use. 

How do you know if you have cataracts?

You might have a cataract if you notice any of these common symptoms:

• Cloudy, blurry, or dim vision
• Impaired night vision
• Sensitivity to bright lights and glare
• Needing brighter light to see or read
• Seeing halos around light sources
• Frequent changes in eyeglass prescriptions
• Colors seem faded or yellow, less vibrant
• Double vision (in one eye typically) 

You should see your ophthalmologist if you have any of these symptoms or other changes in your vision. If you have a cataract, it can be treated by a surgical procedure (cataract surgery) that replaces the cloudy lens with an artificial one known as an intraocular lens (IOL), and in most cases, your Medicare insurance can help you cover some of the cost. 

Does Medicare cover cataracts? 

Original Medicare Parts A (hospital insurance) and B (medical insurance) 

While Original Medicare doesn’t cover routine vision care services, it does cover cataracts. 

Original Medicare Part B (medical insurance) covers the following services associated with cataracts and surgical procedures for those who are eligible: 

• A pre-surgery examination
• The removal of the cataract
• The lens implantation
• Fees for the ophthalmologist
• Fees for the medical facility
• Post-surgical care
• One pair of prescription glasses or one set of contact lenses after cataract surgery 

To be eligible for this coverage, your health care provider (who accepts Medicare assignment) must certify that it is medically necessary. This means that your cataracts are causing considerable vision impairment, you have difficulty doing daily tasks, and corrective lenses aren’t aiding your vision enough. 

In most cases, cataract surgery is done on an outpatient basis, so Original Medicare Part B covers its share of 80 percent of the final approved amount. You must pay 20 percent of the cost after paying your annual Part B deductible. You may also have additional coinsurance charges for the Medicare-affiliated hospital or clinic where you have the surgery.

Medicare Part B also covers 80 percent of the cost for one pair of eyeglasses or contact lenses (up to an allowed amount) after cataract surgery if you get them from a retailer who accepts Medicare assignment.  

If you have cataract surgery while you’re an inpatient in a hospital that accepts Medicare assignment, your surgery is covered by Original Medicare Part A after you pay the Part A deductible for the current benefit period. 

Having cataract surgery with Medicare Advantage (MA) coverage

Cataract surgery is a basic Medicare benefit, so all Medicare Advantage providers must cover it when it’s certified as a medically necessary procedure. Most Medicare Advantage plans also have additional coverage and extra benefits like routine vision care, so you might have lower out-of-pocket costs or more options for eyeglasses and contact lenses. 

Because some types of MA plans use network health care providers, medical facilities, hospitals, and medical suppliers to lower expenses, you might need to stay within this network for your cataract care. If you aren’t sure which physicians are in the network, you should contact your plan provider before making health care appointments. 

How much does cataract surgery cost without Medicare insurance? 

The national average cost for the facility fee and cataract surgery is $1,100, but this doesn’t include the physician’s fee which typically runs between $3,000 and $5,000. Your final cost out-of-pocket also depends on where you have your surgery done and the complexity of the procedure.