Does Medicare Part A Cover Cataract Surgery?

Cataract surgery is a common medical procedure that restores vision. As people age, the eye’s natural lens can become cloudy, leading to impaired vision. Understanding Medicare coverage for this procedure is a frequent concern for beneficiaries. Deciphering Medicare’s coverage for specific treatments like cataract surgery can be complex. This guide clarifies Medicare’s role in covering these procedures.

Understanding Medicare Part A Coverage

Medicare Part A, or hospital insurance, primarily covers inpatient care in hospitals. This includes services such as semi-private rooms, meals, nursing care, and medications administered during a hospital stay. It also extends coverage to short-term skilled nursing facility care, hospice care, and some home health services. Part A focuses on significant medical events requiring formal admission to a facility.

For 2025, beneficiaries are responsible for an inpatient hospital deductible of $1,676 per benefit period. After this deductible is met, Part A covers the full cost for the first 60 days of an inpatient stay. Coinsurance payments begin for longer hospitalizations, costing $419 per day for days 61 through 90 and $838 per day for lifetime reserve days. These lifetime reserve days are a limited number of additional days Medicare will cover, with a total of 60 available over a beneficiary’s lifetime. Most beneficiaries do not pay a monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years.

Medicare Part A and Cataract Surgery

Medicare Part A’s coverage for cataract surgery is generally limited. Routine cataract surgery is typically performed on an outpatient basis, not requiring an overnight hospital stay. Part A’s primary role is for inpatient hospital services, not outpatient medical care, meaning it usually does not cover routine cataract surgery.

Part A would only cover cataract surgery if a medically necessary inpatient hospital admission is required. Such situations are rare, occurring if a patient has severe co-existing medical conditions or complex ocular conditions that necessitate close monitoring in a hospital setting. In these infrequent instances, the Part A deductible of $1,676 for 2025 would apply.

Medicare Part B and Cataract Surgery

Medicare Part B, or medical insurance, is the primary component of Original Medicare that covers cataract surgery. This part of Medicare is designed for outpatient medical services, including doctor’s visits, preventive services, and outpatient surgeries. Since most cataract procedures are performed in an outpatient setting, Part B covers the associated costs. This includes the surgeon’s fees, facility fees whether performed at an ambulatory surgical center or a hospital outpatient department, and anesthesia.

Part B also covers essential services before and after surgery, such as pre-operative exams and post-operative care. After the procedure, Medicare Part B covers one pair of standard prescription eyeglasses or a set of contact lenses. For 2025, the standard monthly premium for Medicare Part B is $185.00, and the annual deductible is $257. Once the deductible is met, Part B covers 80% of the Medicare-approved amount for the surgery, leaving the beneficiary responsible for the remaining 20% coinsurance.

Additional Medicare Coverage and Costs

Even with Medicare Part B covering 80% of approved cataract surgery costs, beneficiaries incur out-of-pocket expenses. These costs include the Part B annual deductible and 20% coinsurance for the Medicare-approved amount. For example, Medicare estimates that a beneficiary’s 20% coinsurance could range from approximately $242 for surgery in an ambulatory surgical center to $456 for a hospital outpatient department. These amounts are in addition to the Part B monthly premium.

To manage these out-of-pocket expenses, several additional Medicare options are available. Medicare Part D, the prescription drug coverage, can help cover the cost of necessary medications, such as eye drops used before or after surgery. The maximum Part D deductible for 2025 is $590, though some plans may have no deductible. Medicare Supplement Insurance (Medigap) can further reduce out-of-pocket costs by covering deductibles, copayments, and coinsurance not covered by Original Medicare. Some Medigap plans may even cover the entire 20% Part B coinsurance, potentially bringing the beneficiary’s out-of-pocket cost for the surgery itself down to zero after the Part B deductible is met. Alternatively, Medicare Advantage Plans (Part C) offer an all-in-one option from private companies. These plans must cover everything Original Medicare (Parts A and B) covers, often including prescription drug coverage and additional benefits like routine vision care. They may have different cost-sharing structures and network rules.