Does Medicare Cover Cataract Surgery?
Find Cheap Medicare Plans in Your Area
Cataract surgery is covered by Medicare, and how much you'll pay for the surgery will depend on which type of Medicare plan you have and the plan's coverage level. For those who have Medicare Part B, the average out-of-pocket cost for cataract surgery ranges from $207 to $783.
One of our top recommendations is to sign up for Medigap Plan G from AARP, which gives you cataract surgery at a $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 taken before or after your 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 (hospitals) | |||
| 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 done as 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 surgery 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 remaining 80%.
After cataract surgery, Medicare Part B covers one pair of corrective lenses. This is the only instance when the plan will cover eyewear. You'll pay 20% of the cost of a set of contact lenses or a pair of eyeglasses with basic frames. Premium frames will cost more.
Medicare Part B doesn't cover prescription drugs, and you'll need a Medicare Part D plan to cover any of the medications you'll take at home before or after the surgery.
Medicare Part C (Medicare Advantage)
Part C plans, also called Medicare Advantage, provide cataract surgery coverage that's at least as good as the coverage provided by Medicare Part B. The coverage level will depend on the benefits included in your plan. After you've met your deductible, you'll pay a copayment amount for each medical service including the outpatient procedure, anesthesia, presurgical appointments and follow-up care.
These bundled Medicare Advantage plans usually include prescription drug coverage, but you should check the plan details to make sure you'll have coverage for the medications you'll need before and after your surgery.
Some Medicare Advantage plans also include vision insurance. This could cover routine optician appointments before and after your 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. Then the supplemental plan is billed second, further reducing your copayment costs by the percentage specified in your plan.
Many Supplement plans will cover the total cost of the Part B copayment. This means, if you've already met your deductible, you won't pay anything for surgery, presurgical appointments, follow-up care and one pair of corrective lenses.
Some plans, such as AARP Medicare Supplement, may also have discounts on routine vision care, but supplemental plans don't include vision insurance. Medigap plans also don't cover prescription drugs, and you'll need a Medicare Part D plan for medications taken before and after your surgery.
Medicare Part D (prescription drugs)
Medicare Part D is a stand-alone drug plan that can cover medications taken before or after your 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 will likely get your prescription drug coverage through that bundled plan.
How much you pay for medications will be determined by the plan's coverage level and the drug's tier classification. For example, many generic drugs are considered Tier 1, which means lower costs. Some of the best Medicare Part D plans, such as the plan from Blue Cross Blue Shield, can 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. The surgery may even be free if you have a plan with a $0 outpatient copayment.
On average, those who only have Original Medicare are paying about $200 to $800 out of pocket per cataract procedure. Below are the average out-of-pocket costs for cataract surgery paid by someone who has 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, and how much you pay will vary based on the following factors:
- Type of facility where you get the surgery done: Costs are lower if you get surgery at a stand-alone surgery center versus an outpatient hospital unit.
- Type of surgery you have: Medicare covers both traditional and laser surgery, but since laser surgery costs more, it may come with higher out-of-pocket costs.
- Your Medicare plan: The type of Medicare you have and the plan's level of coverage also affect how much you'll pay.
What's the best Medicare Advantage plan for cataract surgery?
Medicare Advantage plans unify your Medicare coverage, bringing together Part A, Part B, prescription drug benefits and additional cost-savings for health care.
These plans are similar to traditional health insurance, and you'll usually have a copayment for each procedure or type of medical care. If you're expecting to have a procedure like cataract surgery, choosing a Medicare Advantage plan with low copayments can help keep your costs from piling up for each appointment or procedure.
Medicare Advantage plans can also be a good tool for managing eye conditions. Plans that include vision insurance can give you routine care from an optometrist as well as access to medical eye care from an ophthalmologist.
Medicare Advantage plans we recommend
Best-rated plans but usually only covers procedures at Kaiser's health care facilities.
Look for a Medicare Advantage plan that has:
- Good benefits for outpatient procedures
- A low deductible
- Good coverage for prescriptions
- Vision insurance (for additional routine care)
What's the best Medicare Supplement plan for cataract surgery?
Signing up for a Medicare Supplement (Medigap) plan will give you better coverage for cataract surgery than if you only had Medicare Part B. Those who sign up for a Medigap plan will also need a separate plan for prescription drug coverage.
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:
- We recommend: Plan G for best overall coverage across all medical needs.
- Also good: Plan A, B, D, G, M and N pay 100% of Part B coinsurance, which is your portion of cataract procedure costs.
- Best plans if you're eligible: Plan C and Plan F pay 100% of the Medicare Part B coinsurance and the Part B deductible. However, to be eligible for these plans, you need to have qualified for Medicare before 2020.
Medigap providers we recommend
Largest network and good rates, with Plan G costing between $124 and $209 per month in 2021.
Select a Medicare Supplement company that:
- Has the best monthly costs for the plan letter you choose
- Includes discounted vision care or offers add-on vision insurance
- Has good customer experience with few complaints
Methodology and sources
Our 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 Medicare.gov Procedure Price Lookup and the 2021 public use files from the Centers for Medicare and Medicaid Services (CMS).
Frequently asked questions
How much does cataract surgery cost in 2021?
For those enrolled in Medicare Part B, the out-of-pocket cost for cataract surgery is between $207 and $783. For those who are uninsured, cataract procedure costs can average $1,000 to $4,000 depending on the type of procedure.
What vision coverage does Medicare provide?
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 that can give you limited benefits for reducing eye care costs.
Does Medicare pay for cataract surgery with astigmatism?
Original Medicare does cover cataract surgery. However, cataract surgery using an astigmatism-correcting intraocular lens implant is not covered based on CMS Ruling 1536-R.
Does Medicare cover eye exams, glasses or contact lenses?
Original Medicare does not cover routine eye exams, and it will only cover prescription lenses immediately after a cataract surgery procedure. 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 exam costs.
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