Does Medicare Cover Laser Surgery for Cataracts?

Cataracts, a common age-related condition, involve the clouding of the eye’s natural lens, leading to blurred vision and difficulty seeing clearly. When cataracts significantly impair daily activities, surgical removal becomes necessary to restore vision. For many individuals across the United States, Medicare plays a role in helping cover healthcare costs, including those related to this common procedure.

Medicare’s General Coverage for Cataract Surgery

Medicare Part B covers medically necessary cataract surgery. This coverage extends to the removal of the clouded lens and the implantation of a standard intraocular lens (IOL). Services include the surgeon’s fees, charges for the outpatient facility, and anesthesia administration.

For medical necessity, the cataract must cause symptomatic visual impairment uncorrectable with glasses or contact lenses. This results in functional limitations like difficulty reading, watching television, driving, or performing work tasks. Documentation must show significant impact on daily activities.

Coverage for Laser-Assisted Cataract Surgery

Medicare Part B covers the medically necessary components of cataract removal, whether traditional or laser-assisted. Distinguish between the covered procedure and additional costs of certain technologies. While Medicare covers the core cataract removal and a standard IOL, it does not cover additional charges for laser technology.

Laser use is an elective enhancement providing precision or addressing minor refractive errors like astigmatism, not deemed medically necessary for cataract removal alone. If a patient chooses laser-assisted surgery, Medicare pays for covered components: surgeon’s fee, facility charges, and the standard IOL. The patient is responsible for the additional cost of laser technology and any chosen premium IOLs.

Your Financial Responsibility for Cataract Surgery

Even with Medicare coverage, beneficiaries have out-of-pocket costs. For services covered under Medicare Part B, after meeting the annual deductible, Medicare pays 80% of the Medicare-approved amount; the patient pays the remaining 20% coinsurance. For example, the Medicare Part B annual deductible for 2025 is $257.

Beyond the deductible and coinsurance, patients pay 100% for non-covered elements. This includes laser technology premiums if chosen, or advanced intraocular lenses Medicare considers elective or not medically necessary. Supplemental plans (Medigap or Medicare Advantage) can cover the 20% coinsurance and Part B deductible for covered services. However, these plans do not cover non-covered services like laser premiums or premium IOLs.

Important Considerations Before Surgery

Before surgery, discuss all options with your ophthalmologist and billing staff. Understand differences between traditional and laser-assisted procedures, IOL types, and costs. Confirm Medicare coverage and your financial responsibility.

If your provider recommends a non-covered service or item, they should issue an Advanced Beneficiary Notice of Noncoverage (ABN). An ABN informs you Medicare may not pay for a service or item. Signing it acknowledges financial responsibility if Medicare denies payment. Signing an ABN ensures awareness of potential out-of-pocket expenses before the procedure, allowing an informed decision.