Does Medicare Cover Cataract Surgery?

Medicare Benefits Solutions
Feb 17, 2023

Although Medicare doesn’t cover routine vision care, it does cover standard cataract surgery for all beneficiaries who meet the qualification requirements.

What cataract removal services does Medicare cover:

  • 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

Cataract surgery is covered by different parts of Medicare depending on the nature of your treatment and the type of care you need after the surgery.

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    Medicare Part A Cataract Coverage

    It’s important to note that most cataract surgery is done on an outpatient basis and doesn’t require inpatient care. However, 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. 

    TIP: Check out our Medicare basics page that can help you get the most out of your health insurance benefits.

    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 healthcare providers before and after the procedure to remove cataracts. 

    How much does Medicare pay for cataract surgery in 2023? 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. 

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    What are the Signs That You Need Cataract Surgery?

    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 certain medical conditions like diabetes.

    The top signs you might need cataract surgery include:

    • Blurry vision
    • Cloudy vision
    • Double vision
    • Bright light sensitivity
    • Seeing halos around lights
    • Difficulty seeing in low-light conditions
    • Frequent changes to your prescriptions glasses or contact lenses

    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. 

    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. 

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    Other Cataract and Vision 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.

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