Does Medicare Cover Surgery to Remove Cataracts?

Medicare Benefits Solutions
May 19, 2021

June is Cataract Awareness Month. A cataract, which is a cloudy area in your eye lens, is a common condition among older adults. The National Eye Institute (NEI) advises that “more than half of all Americans age 80 and older either have cataracts or have had surgery to get rid of cataracts.” Medicare suggests that cataracts are also prevalent among people between the ages of 65 and 74. 

Though cataracts may not be noticeable at first, eventually you will notice that your vision is blurry or hazy. This can interfere with your ability to read, watch television or drive. However, this condition can be resolved through a surgical procedure that is safe and effective.

Cataract Surgery

A normal eye lens bends the light rays entering the pupil so you can see clearly. When you experience cloudy vision to the point where you can’t do the things you normally do, it’s time to see an ophthalmologist who may recommend surgery.

Cataract surgery is typically an outpatient procedure. Your cataract surgeon will remove the cloudy lens and replace it with a clear, tiny artificial one called an intraocular lens (IOL). There are several different types of IOLs. Your ophthalmologist can provide guidance on what will work best for you.

The most common type is the monofocal IOL, which focuses on distance and can be set up for close, medium, or distant ranges. If your monofocal IOL is set up for distance vision, you may need glasses for reading or activities that involve close work.

Medicare Benefits for Outpatient Surgery

Does Medicare Cover Surgery to Remove Cataracts? Before the surgery, your ophthalmologist will perform a vision test to check your acuity or clarity. If the test reveals that surgery is medically necessary, it should be covered by Medicare.

Medicare Part B will cover 80% of the approved amount to cover your doctor and the facility. You are responsible for the Part B deductible, the remaining 20% of the Medicare-approved amount, and a copayment to the outpatient center or department.

Medicare Benefits for Corrective Lenses

Though Original Medicare does not include a vision care benefit, corrective lenses following cataract surgery to implant an IOL are an exception. Corrective lenses can be a pair of eyeglasses or a single set of contacts. You are responsible for the coinsurance and deductible.

To receive Medicare benefits for the eyeglasses, the supplier must be enrolled in Medicare and you need to select standard frames. If you want designer frames, you will owe the price differential to the supplier. If you are enrolled in a Medicare Advantage (MA) plan that covers vision care, check your plan benefits for any additional coverage for corrective lenses.

Resources

To learn more about cataract surgery or eye health in general, it may be helpful to contact the American Academy of Ophthalmology (AAO) or the National Eye Institute.