Is Eye Surgery Covered by Medicare?

Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. Its coverage for eye-related services, including surgery, is specific and depends on medical necessity.

Medicare Coverage for Medically Necessary Eye Surgeries

Original Medicare covers services and procedures that are medically necessary to treat a disease, injury, or medical condition. This means the service is required for proper diagnosis or treatment, rather than for cosmetic reasons or vision correction that is not medically mandated. Eye surgeries that fall under this category are covered.

Medicare Part B covers medically necessary eye surgeries performed in an outpatient setting, such as an ambulatory surgical center or a doctor’s office. This includes the surgeon’s fees, facility charges, and necessary supplies. If an eye surgery requires an inpatient hospital stay, Medicare Part A covers the hospital admission.

Cataract surgery is an example of a medically necessary procedure covered by Medicare Part B. This coverage includes the surgical removal of the cataract and the insertion of a standard intraocular lens (IOL). Medicare also covers pre-surgery exams and post-operative care related to the cataract surgery. Following cataract surgery, Medicare Part B pays for one pair of corrective eyeglasses with standard frames or one set of contact lenses.

Treatment for glaucoma, a condition damaging the optic nerve, is also covered by Medicare. This includes screenings for high-risk individuals, outpatient laser surgery, and other surgical interventions. Similarly, surgery to repair a detached retina, an emergency medical condition, is covered under Medicare Part B. Diagnostic tests and treatments for age-related macular degeneration (ARMD), such as eye injections, are also covered.

Eye Surgeries Not Covered by Medicare

Medicare does not cover eye surgeries considered elective or those performed solely for refractive vision correction. Procedures like LASIK (Laser-Assisted In Situ Keratomileusis) or PRK (Photorefractive Keratectomy), which aim to correct nearsightedness, farsightedness, or astigmatism, are not covered. These procedures are not considered medically necessary to treat a disease, as vision can often be corrected with eyeglasses or contact lenses.

Cosmetic eye surgeries are also excluded from Medicare coverage. For instance, eyelid lifts performed purely for aesthetic reasons are not covered. However, if an eyelid lift is medically necessary to correct a functional problem, such as severe drooping eyelids obstructing vision, Medicare may provide coverage. The distinction lies in whether the surgery treats a medical condition or primarily enhances appearance or corrects vision without a medical necessity.

Out-of-Pocket Costs and Supplemental Plans

Even for covered eye surgeries, beneficiaries with Original Medicare are responsible for out-of-pocket costs. Medicare Part B has an annual deductible, which is $257 in 2025, that beneficiaries must pay before Medicare begins to cover services. After this deductible is met, beneficiaries pay a 20% coinsurance of the Medicare-approved amount for most Part B services, including outpatient eye surgeries. Medicare pays the remaining 80%.

If an eye surgery requires an inpatient hospital stay, Medicare Part A’s deductible applies, which is $1,676 per benefit period in 2025. For longer hospital stays, daily coinsurance amounts also apply. There is no annual out-of-pocket maximum with Original Medicare, meaning beneficiaries could face substantial costs for extensive treatments.

Medicare Advantage Plans are offered by private companies approved by Medicare and provide an alternative way to receive benefits. These plans must cover at least everything Original Medicare covers, but they often have different cost-sharing structures, such as copayments or deductibles. They may also offer additional benefits like routine vision care. Beneficiaries enrolled in a Medicare Advantage plan should review their specific plan details to understand their potential costs and benefits for eye surgeries.

Medigap policies work with Original Medicare to help cover out-of-pocket expenses. These private plans can help pay for deductibles, coinsurance, and copayments that Original Medicare does not cover. By purchasing a Medigap policy, beneficiaries can reduce their financial responsibility for medically necessary eye surgeries and other covered services.