Does Medicare Cover Cataract Surgery?
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Cataract surgery is normally covered by Medicare, but how much of the surgery you'll pay for depends on your plan. For those who have Medicare Part B, the average out-of-pocket cost for cataract surgery ranges from $207 to $783.
A top option is to sign up for Medigap Plan G from AARP. It covers cataract surgery 100% ($0 copayment), with an average policy costing about $150 per month. You can also get great coverage with the more convenient Medicare Advantage plan from Aetna, which has cheap monthly rates and includes vision insurance.
Which parts of Medicare cover cataract surgery?
Cataract surgery can be covered by Medicare Part B, a Medicare Advantage plan or a Medicare Supplement plan. For any medications before or after surgery, you'll need prescription drug coverage through a Medicare Advantage plan or a Medicare Part D stand-alone drug plan.
Cataract surgery
|
Before surgery
|
After surgery
| |
|---|---|---|---|
| Part A (hospitalization) | |||
| Part B (medical) | |||
| Part C (Advantage) | |||
| Medigap | |||
| Part D (drugs) |
Medicare Part A (hospitalization)
In most cases, cataract surgery isn't covered under Medicare Part A. This part of original Medicare only covers hospitalizations, and cataract surgery is usually an outpatient procedure. However, Medicare Part A covers rare circumstances where cataract surgery requires hospitalization.
Medicare Part B (medical)
Medicare Part B, the other part of original Medicare, covers cataract procedures, including presurgical ophthalmologist appointments, traditional or laser cataract surgery, anesthesia and follow-up care. If you've already met your Medicare Part B deductible, you'll pay 20% of the surgery cost, and the plan will pay the other 80%.
After cataract surgery, Medicare Part B covers one pair of corrective lenses. This is the only time it will cover eyewear. You'll pay 20% of the cost of a set of contact lenses or a pair of eyeglasses with a basic frame. Premium frames cost more.
Part B doesn't cover prescription drugs, so you'll need a Medicare Part D plan to cover any medications before or after the surgery.
Medicare Part C (Medicare Advantage)
Part C plans, also called Medicare Advantage, are at least as good as Medicare Part B for surgery. Coverage will depend on the benefits included in your plan. After you've met your deductible, you'll have a copayment for each medical service, including the outpatient procedure, anesthesia, presurgical appointments and follow-up care.
These bundled Medicare Advantage plans usually cover prescription drugs, but check the plan details to make sure the medications you'll need before and after surgery are covered.
Some Medicare Advantage plans also include vision insurance. This could cover routine optician appointments before and after surgery, as well as nonsurgical cataract treatments.
Medicare Supplement (Medigap)
If you have a Medicare Supplement plan, you'll pay less for cataract surgery than if you only had original Medicare. Your out-of-pocket cost will be between $0 and 10% of the surgery cost.
The billing happens in two steps. Medicare Part B is billed first, paying 80% of your surgery cost. The supplemental plan is billed second, further cutting your copay by the percentage specified in your plan.
Many supplemental plans cover the total cost of the Part B copayment. So if you've already met your deductible, you won't pay anything for presurgical appointments, surgery, follow-up care and one pair of corrective lenses.
Supplemental plans don't include vision insurance. Some plans, such as AARP Medicare Supplement, may offer discounts on routine vision care though.
Medicare Part D (prescription drugs)
Medicare Part D is a stand-alone drug plan that can cover medications before or after cataract surgery. In most cases, you'll only need a Part D plan if you have original Medicare or a Medigap plan. If you have Medicare Advantage, you likely have drug coverage through that bundled plan.
How much you pay for medications depends on the plan's coverage level and the drug's tier classification. For example, many generic drugs are Tier 1, which means lower costs. Some of the best Medicare Part D plans, such as the one from Blue Cross Blue Shield, provide Tier 1 drugs for free.
How much will cataract surgery cost?
If you have Medicare, you'll pay 20% or less of the total cataract surgery bill. It may even be free if you have a plan with a $0 outpatient copayment.
On average, those who only have original Medicare pay $200 to $800 out of pocket per cataract procedure. Below are the average out-of-pocket costs for someone with Medicare.
Cataract surgery procedure | National average of patient costs with Medicare Part B in 2021 |
|---|---|
| Intracapsular extraction with intraocular lens insertion | $207–$415 |
| Extracapsular removal with intraocular lens insertion | $316–$524 |
| Complex extracapsular removal with intraocular lens insertion | $357–$567 |
| Extracapsular removal with intraocular lens insertion and endoscopic cyclophotocoagulation (ECP) to decrease eye pressure | $488–$783 |
The cost of cataract surgery varies widely. How much you'll pay is based on the following factors:
- Type of facility : Costs are lower if you have surgery at a stand-alone surgery center versus an outpatient hospital unit.
- Type of surgery: Medicare covers both traditional and laser surgery. But laser surgery costs more, so it may come with higher out-of-pocket costs.
- Your Medicare plan: The type of Medicare and level of coverage you have also affect how much you'll pay.
What's the best Medicare Advantage plan for cataract surgery?
Medicare Advantage plans bring together Part A, Part B, prescription drug benefits and additional cost savings for health care.
These plans are similar to traditional health insurance. You'll usually have a copay for each procedure or type of medical care. If you expect to have cataract surgery, choosing a Medicare Advantage plan with low copayments can help keep your costs from piling up for each appointment and procedure.
Medicare Advantage can also be a good tool for managing eye conditions. Plans that include vision insurance can give you access to routine care from an optometrist and medical eye care from an ophthalmologist.
Recommended Medicare Advantage plans
Look for a Medicare Advantage plan that has:
- Good benefits for outpatient procedures
- A low deductible
- Good coverage for prescriptions
- Vision coverage (for additional routine care)
What's the best Medicare Supplement plan for cataract surgery?
A Medicare Supplement (Medigap) plan will give you better coverage than Part B alone for cataract surgery. But you'll need a separate plan for prescription drugs.
Medigap plans have standardized coverage by plan letter. For example, if you have Plan G, you'll have the same surgery costs no matter what company you choose.
Medigap plans:
Select a Medicare Supplement company that: Policy recommendations are based on selections that are a good value, have strong ratings and provide valuable coverage. Medicare quotes and plan details were sourced from Aetna, Highmark, Kaiser Permanente, AARP/UnitedHealthcare, Humana and Cigna. Additional sources include the Medicare.gov Procedure Price Lookup and 2021 public use files from the Centers for Medicare & Medicaid Services (CMS). Medical eye care from an ophthalmologist is covered under Part B, Medicare Advantage and Medicare Supplement plans. Some Medicare Advantage plans include vision insurance for routine optometrist appointments. Some Medigap plans have vision discount programs with limited benefits to reduce eye care costs. Original Medicare covers cataract surgery but not an astigmatism-correcting intraocular lens implant (based on CMS Ruling 1536-R). Original Medicare does not cover routine eye exams. It will only cover prescription lenses if they are needed immediately after cataract surgery. A Medicare Advantage plan may include vision insurance to cover routine eye exams and prescription lenses. Some Medicare Supplement companies include an add-on vision discount program to help you save on eye exams.
Recommended Medigap providers
Methodology and sources
Frequently asked questions
What vision coverage does Medicare provide?
Does Medicare pay for cataract surgery with astigmatism?
Does Medicare cover eye exams, glasses or contact lenses?
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