Does Medicare Cover Cataract Surgery?
If your vision has become blurred, clouded, sensitive to bright lights, or if you have started seeing halos around lights, you might have a cataract. The risk of developing cataracts increases as the years go by, or if you’ve had an eye injury. You may also be more susceptible to getting cataracts because of genetics, long-term use of corticosteroid medications, lifestyle habits like smoking or alcohol use, or having certain medical conditions like diabetes.
These conditions can cause tissue in the eye’s lens to break down and become hazy or cloudy, and make it seem like you’re looking through a foggy window all the time. The resulting clouded vision makes it difficult to do daily activities like driving a car, reading a book, or even seeing your loved ones’ faces clearly.
Medicare Benefits Solutions
Nov 26, 2021
As cataracts slowly develop they may not hinder your eyesight right away. You can turn on brighter lights and get better eyeglasses to function normally. But as they continue to develop, sight worsens. That’s why so many people opt for cataract surgery. It’s a safe, effective procedure that isn’t invasive, and you can have it done as an outpatient in most instances.
Do your Medicare benefits cover cataract surgery?
Medicare insurance covers standard cataract surgery for all beneficiaries who meet qualification requirements. Medicare coverage includes the following services:
- Surgical removal of the cataract(s)
- Implantation of an intraocular lens that is permanently attached inside the eye.
- One pair of prescription glasses or contact lenses
Depending on the nature of your treatment, your cataract surgery, and care associated with the surgery, may be covered by different parts of Medicare.
Medicare Part A cataract coverage
Medicare Part A would cover your inpatient care and hospital costs if you needed to have your procedure done in a hospital, and with a stay of at least three nights. To be eligible for this coverage, the hospital must accept Medicare and your surgery as an inpatient must be certified as medically necessary. Under Medicare Part A, you are responsible for your Part A deductible for the benefit period.
It’s important to note that cataract surgery generally doesn’t require inpatient care.
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Medicare Part B cataract coverage
Medicare Part B covers outpatient-based cataract surgery if your physician accepts Medicare and the procedure is done in a medical facility that also accepts Medicare. Medicare Part B also covers appointments with your health care providers before and after the procedure to remove cataracts.
Your Medicare Part B coverage pays for 80 percent of the final approved costs for your cataract surgery. You pay the remaining 20 percent as well as your Part B deductible for the year.
Medicare Part B also covers certain medications you may need for your surgery. These are medications the physician administers in the medical facility, and not what you would self-administer in your own home afterward.
Other cataract benefits
A stand-alone Medicare Part D prescription drug plan covers prescription drugs you might need after your cataract procedure. Your coverage depends on whether your plan’s formulary includes the medications you require. Your copayment also depends on what your plan charges.
If you have a Medicare Advantage (Part C) plan, you have the same benefits as you would through Original Medicare Parts A and B, and your plan must cover cataract surgery. However, your plan may require that you use health care providers, medical facilities, and medical suppliers that are in the plan’s network of providers. In many cases, your Medicare Advantage plan won’t cover your surgery if you use providers that are not in this set network.
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