Does Medicare Supplement Cover Cataract Surgery?
Demystify cataract surgery expenses. Discover how Medicare and supplemental plans coordinate coverage, clarifying your potential out-of-pocket costs.
Cataract surgery is a common procedure that can significantly improve vision. Medicare and supplemental plans help cover these expenses. This article clarifies Original Medicare’s coverage and how Medicare Supplement plans can reduce out-of-pocket costs for cataract surgery.
Original Medicare Coverage for Cataract Surgery
Original Medicare Part B covers medically necessary cataract surgery, including cataract removal and standard intraocular lens (IOL) implantation. This coverage extends to pre-operative exams, the surgical procedure, and post-operative care, including physician and facility fees.
Beneficiaries face out-of-pocket costs, primarily the annual Part B deductible, which is $257 in 2025. After meeting this deductible, Medicare Part B pays 80% of the Medicare-approved amount for the surgery and related services. This leaves the beneficiary responsible for the remaining 20% coinsurance. While cataract surgery is usually an outpatient procedure, Medicare Part A may provide coverage if an inpatient hospital stay is medically necessary due to complications.
Medicare Supplement Plan Role in Cataract Surgery Costs
Medicare Supplement insurance plans, often called Medigap, help cover out-of-pocket costs not paid by Original Medicare. These plans work with Original Medicare, paying after Medicare has paid its share. Medigap plans are standardized across most states, identified by letters (A through N), ensuring a Plan G, for example, offers the same basic benefits regardless of the private insurance company selling it.
Medigap plans fill the “gaps” left by Original Medicare, such as the Part B deductible, coinsurance, and copayments. For instance, Medigap Plan G covers all Original Medicare out-of-pocket costs, except for the Part B deductible. After the Part B deductible is met, Plan G covers the 20% Part B coinsurance for cataract surgery, often resulting in very low or no additional out-of-pocket expenses. Another common plan, Plan N, also covers the Part B coinsurance but may require copayments of up to $20 for some office visits and up to $50 for emergency room visits, and it does not cover Part B excess charges.
Understanding What is Not Covered
While Original Medicare and Medicare Supplement plans provide coverage for medically necessary cataract surgery, certain related costs and services are not covered. Routine eye exams, for vision correction rather than medical diagnosis or treatment, are excluded from coverage. However, Medicare does cover eye exams if medically necessary to diagnose or treat a specific eye condition like cataracts, glaucoma, or diabetic retinopathy.
Medicare covers one pair of standard prescription eyeglasses or a set of contact lenses after cataract surgery if an intraocular lens (IOL) is implanted. This coverage is for a basic, untinted pair obtained from a Medicare-enrolled supplier. Upgrades to frames, specialized lenses (e.g., anti-reflective coating, progressive lenses), or additional pairs beyond the initial one are not covered.
A key exclusion is the cost of premium or advanced intraocular lenses (IOLs). Original Medicare covers only a standard monofocal IOL. If a patient opts for an advanced IOL designed to correct astigmatism, presbyopia, or provide multifocal vision, they are responsible for the cost difference between the standard IOL and the premium lens. Neither Original Medicare nor Medicare Supplement plans cover this additional cost, as these advanced lenses are considered an elective enhancement beyond what is medically necessary to restore functional vision.