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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.

The good news is that if you’re a Medicare beneficiary and you need surgery, Medicare will most likely cover it.

What are Cataracts?

Cataracts are a condition of the eyes that affects millions of people. The lens of the eye becomes clouded, most commonly due to age. In most cases, the condition takes a long time to develop before you realize that there’s an issue.

Some symptoms you’ll want to watch for include:

  • Vision that has become cloudy or blurred
  • A constant glare
  • Driving at night has become difficult or impossible
  • Colors look the same
  • Double vision

What are the Medicare Requirements for Cataract Surgery?

It’s relatively simple to meet Medicare’s requirements for cataract surgery. Typically, both of the following statements must apply to you:

  • Your doctor says that cataract surgery is medically necessary
  • You receive your surgery and treatment from a healthcare provider that accepts Medicare

What Does Medicare Pay for Cataract Surgery?

While Medicare will pay for cataract surgery, it doesn’t cover the costs in full. Medicare covers 80% of your medical costs, including:

  • The surgery
  • Ophthalmologist exams and facility charges
  • Pre-surgery exams
  • Post-surgery exams

Medicare will not cover the costs of:

  • The remaining 20% of your bill
  • Deductibles
  • Excess charges, where applicable
  • Medications
  • Copayments
  • Coinsurance

In these instances, you’ll either pay out of pocket, or your other forms of insurance will pick up the costs. For instance, if you have a Medicare Supplement plan, it may cover all of your medical expenses. Your medications would be covered under your Medicare Part D prescription plan. As long as Medicare approves your surgery, your Medicare Supplement plan will pay its portion as well. 

What Type of Cataract Surgery does Medicare Cover?

Medicare will cover cataract surgery performed manually with a blade, and laser surgery. In addition, Medicare will pay for intraocular lenses for presbyopia or astigmatism, only if they if they need to be placed due to cataracts.

Does Medicare Pay for Glasses After Cataract Surgery?

Medicare will cover your first pair of glasses after cataract surgery. This is one of the few instances in which vision expenses are paid for, as they aren’t usually covered by Medicare. 

How do I Estimate My Cost for Cataract Surgery?

It’s easy to determine your costs for cataract surgery if you have a Medicare Supplement plan. You can do so by performing the following steps:

  • Review your plan details, looking specifically for coverage for deductibles, coinsurance, and excess charges
  • Ensure that your doctor and all related care providers accept Medicare
  • Contact your Part D prescription provider to determine the costs of any antibiotics or painkillers that you’ll be prescribed

If you have Medicare alone, you’ll need to:

  • Ask for a breakdown of what’s charged for each step of the procedure
  • Find out which parts of the procedure are covered 100 percent and subtract that amount from the total cost of the operation
  • Plan on paying 20 percent of the amount that is not completely covered
  • Determine your prescription medication costs
  • Determine copayment in advance for after surgery care and doctor follow-up

If you have a Medicare Advantage plan, you’ll need to contact your carrier directly. These plans can vary widely, so ask what steps you need to take to determine your costs.

How Do I Know if I Need Cataract Surgery?

If your vision is being obstructed or impaired by cataracts, consult with your doctor. Your doctor will ultimately be the best resource to help you decide if you need surgery. And in the event that you do need surgery, you can rest easy knowing that you’ll most likely be covered by your Medicare plan.

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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