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Does Medicare Cover Cataract Surgery?

If you’re over 65-years-old, and your vision has suddenly become blurry and cloudy, you may have cataracts. This condition worsens with age, and can become quite uncomfortable.

If this has happened to you as a Medicare beneficiary and you need surgery, you’re likely wondering if Medicare will cover your cataract surgery, or if you’ll have to pay out of pocket.

Does Medicare Cover Cataract Surgery?

Medicare will cover your cataract surgery if your doctor recommends it as medically necessary. Medicare will also cover doctor services and related care following the surgery.

Unless you have a Medicare Supplement or other coverage, you may be responsible for certain costs, including deductibles, copayments, and/or coinsurance.

What Are Cataracts?

A cataract is a clouding of the lens in the eye, which affects your vision. Most cataracts occur due to aging, and are very common in older people.

Most cataracts develop slowly and don’t disturb your vision early on. But with time, cataracts may interfere with your vision. Cataracts can occur in either or both eyes.

What Causes Cataracts?

Most cataracts develop when aging changes the tissue that makes up your eye’s lens.

The lens is made of mostly water and protein, which is arranged in a precise way to keep the lens clear. However, age-related issues can cause the protein to clump together, clouding small areas within the lens. This is a cataract.

As you age, the lenses in your eyes become less flexible, less transparent and thicker. Age-related conditions cause tissues within the lens to break down and clump together, clouding small areas within the lens.

Though the cataract may not interfere much with your vision at first, it can continue to develop and grow larger, clouding more of the lens and, thus, making it harder to see.

What Are The Symptoms of Cataracts?

The most common symptoms of a cataract are:

  • Cloudy or blurry vision
  • Glare
  • Poor night vision
  • Faded colors
  • Double vision

How Do I Know If I Need Cataract Surgery?

The right time to have cataract surgery is unique to each individual. Your doctor will likely recommend surgery if it is medically necessary to treat your symptoms.

Cataract surgery is typically performed on an outpatient basis. During the surgery, your surgeon will remove the cloudy lens and replace it with an artificial lens to restore clear vision.

Typically, cataract surgery will be performed on one eye at a time, with a few weeks in between each surgery to give the first eye time to heal.

How Does Medicare Cover Cataract Surgery?

Medicare covers cataract surgery, but only expenses that are directly related to the cataracts.

Medicare covers the approved amounts for your fees from your ophthalmologist and the facility. This means you will be a 20% coinsurance for Part B, as well as your Part B deductible. If you have a Medicare Supplement insurance policy, some or all of these extra costs may be covered.

Medicare also covers your pre-surgery exam, as well as any follow-up care. Again, without a Medicare Supplement, you’ll be required to pay 20% coinsurance and your Part B deductible.

Does Medicare Cover Eyeglasses for Cataract Surgery?

Normally, vision care is not covered by Medicare, and you would need to purchase a separate insurance policy to receive coverage. However, following your cataract surgery, Medicare will cover eyeglasses, contact lenses and intraocular lenses.

You will merely need to pay the 20% Part B coinsurance and Part B deductible. If you have a Medicare Supplement, these costs may be fully or partially covered.

GoMedigap Can Help

Though Medicare covers some of the costs for cataract surgery, there are still some gaps in coverage, including your Part B deductible, 20% coinsurance and more. Purchasing a Medicare Supplement can help cover some or all of those costs.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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