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Cataracts are a common eye condition for many Americans. This condition is a clouding of your eyes’ natural lenses that cause foggy or blurry vision. Aging is the most common cause of cataracts. In fact, more than 20 million Americans over 40 are affected by it. But cataract surgery can help correct the problem and improve your vision – and Original Medicare can help pay for it.

Original Medicare (also known as Medicare Part A and Part B) will cover either traditional or laser surgery for cataracts. Since cataract surgery is usually an outpatient procedure, it falls under your Part B (medical insurance) coverage. Once you’ve paid your annual Medicare Part B deductible, you will only need to pay the remaining 20%. Medicare will also cover the cost of prescription eyeglasses or contact lenses that may be needed after the surgery.

Conditions for Medicare Coverage

First, your doctor must diagnose that you have cataracts. Then, it must be determined that the condition is negatively affecting your daily activities, including:

  • Driving
  • Working
  • Reading
  • Watching TV

Medicare will then cover a standard intraocular lens (IOL) implant. Be aware that if you choose a more advanced lens to correct astigmatism or nearsightedness, you will have to pay for part or even all of the cost for the upgrade.

Post-Surgery Costs and Coverage

In general, Medicare Part B covers the full cost of cataract surgery. This includes a pre-surgery exam and any post-surgery care. It will also cover any ophthalmologist and facility fees. After you meet the Part B deductible, you’ll pay the 20% coinsurance for the surgery and anesthesia. For example, if the total cost of your cataract procedure is $2,000, you would pay $400 (20% of $2,000) after you’ve met your deductible. Medicare would then cover the remaining $1,600.

But since all necessary services can vary from patient to patient, it’s difficult to know what the final cost will be. The exact amount you’ll owe may depend on several things, including:

  • Other insurance you may have, including Medicare Advantage.
  • How much your doctor charges.
  • If your doctor accepts the assignment.
  • The type of facility where the surgery is performed.
  • Where you get the tests or services involved.

To help figure out how much you may have to pay, talk to your doctor or health care provider.

Alternative Coverage Options

While Original Medicare will cover traditional surgery, there are options for additional coverage. Medicare Advantage plans, also called Part C, allow for:

  • Enhanced Coverage – These plans often offer extra benefits beyond what Original Medicare covers. This can include coverage for advanced lenses that correct astigmatism, as well as care before and after the cataract surgery.
  • Cost Savings – Most plans have annual out-of-pocket maximums designed to protect you from high medical costs. This can help give you financial peace of mind if you’re considering cataract surgery.
  • Care Coordination – You get a group of doctors who know about your health history and can help you throughout the process of cataract surgery.

Medicaid is another option for people who qualify based on income. And if you have to pay out-of-pocket, some healthcare providers offer payment plans or even discounts. Clear vision is so important for your everyday life, allowing you to read, drive and work. Cataract surgery can help restore your sight so you can enjoy the world around you.

Medicare helps many people dealing with cataracts, covering the cost of the surgery and follow-up care. And a Medicare Advantage plan can offer additional support, including advanced lens options and post-operative care. Contact us today for more information on how a Wellcare Medicare Advantage plan can help with your hearing needs.

Cataract Surgery Medicare Coverage Questions

What type of lens does Original Medicare cover for cataract surgery?

Medicare covers standard intraocular lens (IOL) implants. It will not pay for a more advanced lens that corrects astigmatism or nearsightedness.

What is the Medicare-approved amount for eyeglasses after cataract surgery?

Medicare usually covers one pair of eyeglasses or contact lenses after cataract surgery that implants an intraocular lens. But the Medicare-approved amount can vary. If you choose a designer frame or specialized lenses, you may have to pay the difference.

Does Medicare pay for cataract surgery with astigmatism?

Generally speaking, no. Medicare only covers necessary cataract surgery using standard intraocular lenses. It won’t cover advanced lenses or elective surgery that’s made to correct astigmatism or nearsightedness.

 

Which Medicare Advantage Plan is right for you?

Call us today to learn more and enroll.

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Disclaimers

Sources
Centers for Disease Control & Prevention: Vision Health - Cataracts
Medicare.gov - Eyeglasses and Contact Lenses

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Y0020_WCM_134133E Last Updated On: 2/20/2024