How Does Medicare Cover Cataract Surgery? 

Cataracts are a common vision problem faced by seniors, but left untreated, cataracts have the potential to lead to total blindness. Many seniors don’t notice cataract symptoms at first. This is because they typically come on gradually and only really begin to affect vision once a cataract has progressed to a more serious state.

What is a cataract?

The formation of a cataract is due to the breakdown of certain proteins and other microscopic tissue in the lens of the eye. As this process continues, the lens becomes cloudy in appearance and begins to interfere with vision. Cataracts can develop in one or both eyes, and they typically begin to affect people over the age of 60 despite developing in individuals as early as 40 years of age.

How are cataracts treated?

The most effective and common treatment for cataracts is surgery. Cataract surgery involves removing the lens of the affected eyeball and replacing it with an artificial lens. While this may sound like a major procedure, cataract surgery can typically be completed on an outpatient basis in as little as 30 minutes. If you are scheduled for cataract surgery, you will likely need to plan for a few hours at least given the time that it takes to check in at your surgery center and recover after the surgery is completed. Discuss the details of the procedure with your doctor.

How does Medicare cover cataract surgery?

Original Medicare provides benefits for cataract surgery through Part B, the outpatient benefit. Medicare Part B benefits also covers doctor visits and durable medical equipment (DME). For most Medicare recipients, the cost of carrying Part B coverage requires a monthly premium, and there is also a deductible that must be met prior to Medicare coverage applying toward medical costs.

If your cataract surgery is undertaken as part of your treatment while formally admitted to a Medicare-participating hospital or skilled nursing facility, Medicare Part A would provide coverage instead of Part B. Medicare Part A is inpatient coverage, and it is usually available with no premium required based on taxes paid while working. Medicare Part A does still require a deductible. Additionally, Medicare Part A will only cover inpatient care for a limited amount of time each benefit period.

Corrective lens coverage

You may already know that Original Medicare benefits are not available for standard vision care. This means things like routine eye exams and glasses or contacts are not covered by Medicare. Things are a little bit different after cataract surgery, however, as Original Medicare covers the cost of one pair of corrective lenses to be worn during recovery. These lenses can be either glasses with a standard frame or contacts.

It should be noted that Medicare will not continue to cover the cost of corrective lenses beyond this one pair, and this coverage only applies in the event of cataract surgery. Additionally, Medicare coverage will provide benefits for the cost of an intraocular lens to be implanted as a replacement for the lens that is removed during cataract surgery.

Medicare Advantage and cataract surgery coverage

Medicare Advantage (MA) plans include the same coverage as Original Medicare, including the outpatient benefits of Part B when it comes to cataract surgery. The difference is that a Medicare Advantage plan may include additional benefits not found in Original Medicare coverage. Each MA plan is different, however, so whether or not your plan would include additional benefits that would apply toward cataract surgery would be dependent on your plan provider.