Does Medicare Pay For Cataract Surgery?
Yes, cataract surgery generally is considered a medically necessary surgical procedure and usually is covered by Medicare.
In order for your cataract surgery to be considered "medically necessary" your visual acuity will have to be significantly affected. Your eye surgeon can discuss this with you in greater detail during your comprehensive eye exam.
If you choose premium products and services for your cataract surgery — such as laser cataract surgery or a premium intraocular lens (IOL) for the treament of presbyopia — you may have significant out-of-pocket expenses that Medicare will not cover.
Medicare covers basic cataract surgery and IOLs, but not the added cost of certain premium IOLs or procedures.
During your pre-op exam and consultation, your cataract surgeon will discuss with you the different options available and the associated costs not covered by Medicare.
Often, choosing a premium IOL or an additional procedure such as limbal relaxing incisions (LRI) to correct astigmatism may significantly improve your satisfaction with your vision after surgery and is well worth the added expense.
Many surgeons offer financing plans to make payment for non-Medicare-covered products and services more affordable. Also, your surgeon's business staff can help you understand exactly what will and will not be covered by Medicare and any supplemental insurance plan you have.
Also, Medicare Part B (Medical Insurance) helps pay for just one pair of eyeglasses or one set of contact lenses following cataract surgery with IOL implantation. Medicare will pay for eyeglasses or contact lenses only when provided by a supplier enrolled in Medicare, no matter who submits the claim (you or your eye doctor or optician).
Remember: Prior to your cataract procedure, talk to your eye doctor and make sure you understand which services and products Medicare will cover and which you are responsible for paying yourself.
About the Reviewer: Vance Thompson, MD, FACS, is the director of refractive surgery at Vance Thompson Vision in Sioux Falls, S.D. He also is professor of ophthalmology at the Sanford USD School of Medicine, a leading researcher in technologies for laser and implant vision correction and a member of All About Vision's editorial advisory board.
Page updated August 2017