Does Medicare Pay for Eyeglasses After Cataract Surgery?
Navigate Medicare coverage for eyeglasses post-cataract surgery. Get clear answers on Original Medicare, Advantage plans, and Medigap options.
Cataract surgery is a medical procedure that improves vision by replacing a cloudy natural lens with an artificial one. Following this procedure, individuals often require vision correction, such as eyeglasses or contact lenses. This article clarifies Medicare’s coverage policies regarding these items after cataract surgery.
Coverage for Eyeglasses After Cataract Surgery
Medicare Part B typically covers one pair of corrective lenses (eyeglasses with standard frames or contact lenses) if needed after cataract surgery involving an intraocular lens implantation. This coverage applies to the initial pair of standard corrective lenses obtained after the surgery. Original Medicare generally does not cover additional pairs, upgraded frames, or non-standard lenses.
After satisfying the Medicare Part B deductible, individuals are responsible for 20% of the Medicare-approved amount for these corrective lenses. Coverage is available after each cataract surgery performed on an eye that receives an intraocular lens. Ensure the supplier of eyeglasses or contact lenses is enrolled in Medicare for coverage to apply.
What Medicare Covers for Cataract Surgery Itself
Medicare Part B generally covers medically necessary cataract surgery, including cataract removal and standard intraocular lens (IOL) implantation. This coverage includes pre-operative examinations, the surgical procedure, facility fees, and post-operative care, which typically extends up to 90 days. Medicare specifically covers standard monofocal IOLs.
Premium intraocular lenses, such as those designed to correct astigmatism or provide multifocal vision, are typically not covered by Medicare. If a beneficiary chooses a premium lens, they are responsible for the cost difference between the standard lens and the upgraded option. After the Part B deductible is met, beneficiaries usually pay 20% coinsurance for the Medicare-approved costs of the surgical procedure.
Understanding Medicare Advantage and Medigap
Medicare Advantage (Part C) plans offer an alternative to Original Medicare and provide at least the same benefits as Parts A and B. Many Medicare Advantage plans include additional benefits, which may extend to more comprehensive vision coverage. These benefits could include allowances for upgraded frames, additional pairs of eyeglasses, or routine eye exams beyond what Original Medicare provides.
Medigap, or Medicare Supplement Insurance, policies function differently. These plans help cover out-of-pocket expenses such as deductibles, copayments, and coinsurance for services that are covered by Original Medicare. However, Medigap policies do not typically offer extra benefits like routine vision care or additional eyeglass coverage that Original Medicare does not cover. It is advisable to contact specific plan providers to understand the exact coverage details for both Medicare Advantage and Medigap policies.