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Does Medicare Cover Cataract Surgery?  

Does Medicare Cover Cataract Surgery?  

Cataract surgery is a procedure performed by an eye doctor that removes the lens of your eye and replaces it with an artificial lens. The surgery is suggested when cataracts cause your lens to cloud, making your vision blurry and daily activities difficult. 

Original Medicare (Part A and Part B) doesn’t include vision insurance. So if you have cataracts, you will likely think that you need to pay out of your own pocket for surgery. 

However, Original Medicare does pay for cataract surgery. The government considers cataract surgery to be medically necessary, so it’s covered. In this post, we explain what Medicare covers and how much you can expect to pay:

Cataract Surgery Coverage With Medicare 

Medicare covers preoperative care, surgery, and postoperative care for a full 90 days following the procedure. It also covers postoperative complications that are addressed in the office. Also, Medicare covers glasses or contacts if you need them following your cataract surgery. 

Conversely, Original Medicare only covers basic cataract surgery. 

A basic cataract procedure involves the surgeon using a blade to remove the lens. The surgeon then replaces it with a monofocal lens – a lens that replaces the cloudy lens, but it doesn’t enhance your vision. Subsequently, you might still require contacts or glasses after cataract surgery. 

It is possible, though, to upgrade your surgery by paying the additional costs out of your own pocket. For instance, you can get bladeless surgery and multifocal lenses, so you don’t require glasses or contacts. You will pay the remaining balance after Medicare pays for the standard procedure. Talk to the provider to find out exactly how much the out-of-pocket costs will be before moving forward. 

Out-of-pocket Costs for Cataract Surgery

Medicare Part B pays for the fees associated with cataract surgery. However, you will have to pay your Medicare Part B coinsurance and the deductible. The coinsurance is 20 percent and  the deductible for Medicare Part B is $185 in 2019. The deductible usually goes up slightly from one year to the next.  

Reducing Out-of-pocket Costs for Cataract Surgery

Many people can reduce out-of-pocket costs while improving coverage by choosing the Medicare Advantage (Medicare Part C) Program. The program allows for additional private plans that are available on the insurance marketplace and provide the same benefits as Medicare, although most include extras as well. You might be eligible for different lenses and types of cataract surgery under the Medicare Advantage Program. It’s important to read the fine print to determine what is covered and what your out-of-pocket costs will be. 

Get Help Finding the Right Coverage

Medicare does cover cataract surgery, but you might get better coverage with the Medicare Advantage Program. This can be confusing, so seek help from a licensed insurance agent. An insurance agent will compare plans and help you find the right one for your medical needs.