Does Medicare Cover Secondary Cataract Surgery?

Many individuals experience a clouding of the lens capsule after initial cataract surgery, a condition often referred to as a secondary cataract. This can lead to blurred or hazy vision. YAG laser capsulotomy is a quick and effective outpatient procedure to address this.

Medicare Coverage for Secondary Cataract Surgery

Medicare covers medically necessary YAG laser capsulotomy. This coverage falls under Medicare Part B, as the procedure is typically performed in an outpatient setting. Medicare considers it a covered service when medically necessary to restore vision significantly impaired by posterior capsular opacification (PCO), the technical term for the cloudy lens capsule.

The procedure involves using a laser to create a small opening in the clouded capsule, allowing light to pass through to the retina and improving vision. Medicare Part B also covers related services, including diagnostic examinations, medications administered during the procedure, necessary supplies, and up to a year of follow-up care related to the procedure.

Understanding Your Out-of-Pocket Costs

While Medicare Part B covers medically necessary YAG laser capsulotomy, beneficiaries are responsible for certain out-of-pocket costs. Before Medicare begins to pay its share, individuals must first meet their annual Medicare Part B deductible. For 2025, the Part B annual deductible is $257.

After the deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount for covered outpatient services, including YAG laser capsulotomy. This means the beneficiary is responsible for the remaining 20% coinsurance. For example, if the Medicare-approved amount for the procedure is $1,000, and the deductible has been met, Medicare would pay $800, and the beneficiary would owe $200.

Medicare Advantage Plans, also known as Medicare Part C, must cover at least the same services as Original Medicare (Parts A and B), including YAG laser capsulotomy. However, these private plans may have different cost-sharing structures, such as copayments or deductibles, and may also have network restrictions. Beneficiaries enrolled in a Medicare Advantage Plan should contact their specific plan to understand their financial responsibilities and any network limitations.

Medigap (Medicare Supplement Insurance) plans can help cover some or all of the out-of-pocket costs associated with Original Medicare, such as the Part B deductible and coinsurance. These plans are offered by private insurance companies and can significantly reduce a beneficiary’s financial burden for covered services. It is advisable for beneficiaries to confirm coverage and estimated costs with their healthcare provider’s office and their specific Medicare plan (Original Medicare, Medicare Advantage, or Medigap) prior to the procedure.