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Does Medicare Cover Cataract Surgery?

September 26, 2023

Does Medicare Cover Cataract Surgery?

Cataracts are a serious vision problem that can cause you to lose vision in one or both eyes. They occur when your eye’s natural lens becomes cloudy due to a breakdown in the proteins in your eye.

If you’re older and have Medicare, you might wonder “Is cataract laser surgery covered by Medicare?” or whether Medicare covers other types of cataract surgery. This guide will answer common questions about Medicare and cataract surgery and should help you understand your coverage for this important procedure.

Does Medicare Pay for Laser Cataract Surgery?

There are multiple ways to do cataract surgery, but the easiest is using a laser. You might be wondering, “Does Medicare cover cataract surgery with a laser?” The answer is yes, Medicare covers both traditional and laser cataract surgery. You’ll need to choose a doctor that accepts Medicare assignments.

If you have a Medicare Advantage plan, you’ll have at least as much coverage as Original Medicare. You may get additional benefits as well, such as lower copayments, coverage of other vision health care, and more. Contact your insurance plan provider directly for details, and keep in mind that you’ll need to choose a provider within the plan’s network.

Medicare Requirements for Cataract Surgery

Medicare only covers medical procedures when they are medically necessary. A doctor will determine the medical necessity of surgery for your cataract issues based on how badly your vision is impaired.

When you first get cataracts, they may not affect your vision very much. However, over time things will get blurrier. Eventually, you will need surgery to protect your vision. Cataracts are easily correctable, and Medicare will provide coverage for surgery and even replacement of your interocular lens.

What Does Cataract Laser Surgery Cost With Medicare?

Cataract surgery can be very expensive without health insurance. With Medicare, you’ll pay significantly less.

Medicare Part B covers the surgery, so you’ll need to pay your Part B deductible first if you haven’t already. Then, you’ll be responsible for 20% of the Medicare-approved cost of the procedure (which is less than the non-insurance cost).

With a Medicare Advantage plan, you’ll have a similar arrangement but the amounts may be different. You’ll have an annual deductible to meet, and then either coinsurance or a copayment. Many times an outpatient procedure like cataract surgery will have a flat copayment amount instead of a percentage. That can help you plan for the expense more easily. Learn more about Medicare deductibles, premiums, and copayments in this guide to 2022 changes to Medicare.

Does Medicare Cover Eye Drops for Cataract Surgery?

In general, Medicare doesn’t pay for eye care. After cataract surgery, you may be able to get one pair of eyeglasses with standard frames or contact lenses if you had an interocular lens implanted. The supplier must be enrolled with Medicare.

Other items related to your eye care and recovery, such as eye drops, are generally not covered under Original Medicare. However, if you have a Medicare Advantage plan, you may have additional coverage. That may include coverage for eye drops and other after-surgery care for your eyes.

Contact Us to Learn More About Medicare and Cataract Surgery

This guide has answered the most common questions we hear about Medicare and cataract surgery. You might still have concerns related to your specific situation, however. That’s when talking to a licensed insurance agent can help. Contact us to learn more about Medicare coverage and to ensure you have the right plan for your needs.

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