Does Medicare Cover Cataract Surgery and Implants?

Cataract surgery addresses vision impairment from cataracts, which are cloudy areas in the eye’s natural lens that cause blurry, hazy, or less colorful vision, similar to looking through a foggy window. The surgery involves removing the clouded lens and, in most instances, replacing it with an artificial intraocular lens (IOL) to restore clear vision. It is typically an outpatient procedure.

Medicare Coverage for Cataract Surgery

Medicare Part B, which covers outpatient services, is the primary component of Original Medicare involved in covering cataract surgery. This coverage extends to the surgical procedure itself, including traditional and laser-assisted techniques, along with pre-operative examinations and post-operative care. For Medicare to cover the procedure, a doctor must determine that the cataract surgery is medically necessary, meaning cataracts significantly impair daily activities like driving or reading. Medicare also covers one pair of prescription eyeglasses with standard frames or one set of contact lenses after the surgery, which is an exception to its usual policy on routine vision services.

Intraocular Lens Coverage

Medicare covers the cost of a standard monofocal intraocular lens (IOL) implanted during cataract surgery. These standard IOLs provide clear vision at a single distance, most often set for far vision. Patients with standard IOLs may still need corrective eyewear for near or intermediate tasks like reading or computer use. However, premium or advanced IOLs, such as multifocal, toric, or accommodative lenses, are generally not fully covered. The additional cost for these specialized lenses, which can correct astigmatism or provide vision at multiple distances, becomes the patient’s financial responsibility as their refractive benefits are considered non-covered services.

Patient Cost Sharing

Even with Medicare coverage, beneficiaries will incur certain out-of-pocket costs for cataract surgery. For 2025, the annual Medicare Part B deductible is $257. After this deductible is met, Medicare Part B typically pays 80% of the Medicare-approved amount for the surgery and associated services, leaving the patient responsible for the remaining 20% coinsurance. These out-of-pocket expenses can be managed through supplemental insurance options. Medicare Supplement (Medigap) plans can help cover the 20% coinsurance and deductibles, potentially reducing patient costs to very little or even zero, depending on the specific plan. Medicare Advantage (Part C) plans, offered by private companies, also cover cataract surgery and may have different cost-sharing structures, such as fixed copayments instead of coinsurance, and often include an annual out-of-pocket maximum. Costs under a Medicare Advantage plan vary based on the plan’s design and network.

Steps for Coverage

To help ensure Medicare coverage for cataract surgery, several practical steps are beneficial for beneficiaries. It is important to confirm that the ophthalmologist and surgical facility accept Medicare assignment, meaning they agree to charge only the Medicare-approved amount for services. While Original Medicare generally does not require pre-authorization for medically necessary cataract surgery, some Medicare Advantage plans might have pre-authorization requirements. Beneficiaries with Medicare Advantage plans should check with their plan provider regarding any specific authorization processes to avoid delays or denials of coverage. Discussing potential costs and coverage details with the healthcare provider’s billing department before the procedure can also provide clarity on financial responsibilities.