What Does Medicare Cover for Cataract Surgery?

Cataract surgery is a widely performed procedure that significantly improves vision clarity. Cataracts, a common age-related condition, cause the eye’s natural lens to become cloudy, impairing daily activities. Medicare serves as a primary source of healthcare coverage for many seniors. This article clarifies Medicare’s assistance with cataract surgery costs and coverage.

Understanding Original Medicare Coverage for Cataract Surgery

Original Medicare, comprising Part A and Part B, provides coverage for medically necessary cataract surgery. Most cataract procedures are performed in an outpatient setting, falling primarily under Medicare Part B (Medical Insurance). Part B covers services related to the surgery, including fees for the surgeon and anesthesiologist, and facility fees at ambulatory surgical centers or hospital outpatient departments.

Medicare Part B covers the cost of a standard, monofocal intraocular lens (IOL) implanted during the surgery. It covers pre-operative exams to diagnose cataracts and determine the need for surgery. Part B also covers post-operative exams and follow-up care for up to 90 days. It also contributes to the cost of one pair of prescription eyeglasses with standard frames or contact lenses after surgery.

Medicare Part A (Hospital Insurance) covers a hospital inpatient stay if medically necessary for cataract surgery. Inpatient admissions for this procedure are rare, but if required, Part A covers eligible hospital expenses. In 2025, the Medicare Part A deductible is $1,676 per benefit period.

Costs and Non-Covered Services Under Original Medicare

While Original Medicare covers medically necessary cataract surgery, beneficiaries are responsible for out-of-pocket expenses. Under Part B, after meeting the annual deductible, typically $257 in 2025, patients are responsible for 20% of the Medicare-approved amount for the surgery and related services. This coinsurance applies to surgeon’s fees, facility charges, and other covered aspects.

Original Medicare does not cover advanced or premium intraocular lenses (IOLs). These include toric, multifocal, or extended depth of focus lenses. If a patient chooses a premium IOL, they are responsible for the difference in cost between the standard IOL covered by Medicare and the advanced lens.

Medicare does not cover procedures or services solely for correcting refractive errors like astigmatism or presbyopia. Medicare considers these services as replacing eyeglasses or contact lenses, which are not covered. Purely cosmetic or elective vision correction procedures not medically necessary for cataract removal are also not covered.

How Medicare Advantage Plans Cover Cataract Surgery

Medicare Advantage (MA) Plans, also known as Medicare Part C, offer an alternative to Original Medicare. Private insurance companies approved by Medicare provide these plans, which must cover at least the same services as Original Medicare Parts A and B, including medically necessary cataract surgery.

While cataract surgery coverage is equivalent to Original Medicare, cost-sharing can differ significantly. MA plans often have different copayments, coinsurance, and deductibles than Original Medicare. Many MA plans also have network restrictions, requiring patients to use in-network doctors and facilities for full coverage.

Patients enrolled in a Medicare Advantage plan should consult their specific plan’s Summary of Benefits. The Summary of Benefits details specific costs, such as copayments for specialist visits or facility fees, and network requirements for cataract surgery. Some MA plans may also offer additional vision benefits beyond Original Medicare, such as routine eye exams or eyewear allowances.

Role of Medigap Policies and Other Insurance

Medigap policies, also known as Medicare Supplement Insurance, supplement Original Medicare to cover out-of-pocket costs. Sold by private companies, they help pay for expenses like the Medicare Part B deductible and the 20% coinsurance not covered by Original Medicare. A Medigap plan can significantly reduce or eliminate a beneficiary’s financial responsibility for covered cataract surgery costs.

Different Medigap plans, like Plan G or Plan N, offer varying levels of coverage for these out-of-pocket expenses. For instance, Plan G covers all Part B coinsurance and excess charges, covering the remaining 20% of the Medicare-approved amount for cataract surgery after the Part B deductible is met. Medigap policies only work with Original Medicare, not with Medicare Advantage Plans.

Beyond Medigap, other insurance may also help cover cataract surgery costs. Employer-sponsored retiree health plans can coordinate benefits with Medicare, potentially reducing out-of-pocket expenses. Medicaid, a state and federal program for low-income individuals, can sometimes assist with Medicare premiums and cost-sharing for cataract surgery, depending on eligibility.