Once you hit your 60s, the odds increase of needing cataract surgery to fix cloudiness in the lens of your eye and blurry vision. If you have cataract surgery, the cataract will be replaced with a new and artificial one. The result: clear vision.
But if you need cataract surgery after 65 and incur related costs, will Medicare cover this?
The answer, like so much about Medicare, isn’t simple.
“Medically necessary” cataract surgery
Medicare does cover cataract surgery through Medicare Part B if the procedure is considered “medically necessary” and done using what are called “traditional surgical techniques” or using lasers. This means you’ll receive a small, clear, conventional intraocular lens or IOL.
This coverage can be a substantial savings for you since cataract surgery often costs about $1,800 to $2,800.
Medically necessary, “basically means the cataract is interfering with your ability to do things you need to do or things you want to do,” says Dr. David Glasser, the American Academy of Ophthalmology secretary for federal affairs and an assistant professor in ophthalmology at Johns Hopkins University. “Removing it is likely to fix that.”
If your surgery will qualify for Medicare coverage, you’ll generally pay a 20% coinsurance amount for it and the anesthesia. You’ll be responsible for any of your annual Medicare Part B deductible ($226) you haven’t yet paid, plus physician fees such as an anesthesiologist assisting with the surgery.
Medicare will cover the rest, including a pre-surgery exam, post-surgery care and the cost of seeing an ophthalmologist and paying related fees.
Often, people who need cataract surgery get it done in both eyes, spaced out over a few weeks. But some only need the surgery in one eye.
The type of cataract surgery with reduced Medicare coverage
If you get a type of laser cataract surgery with more advanced technology lenses known as PC-IOLs (posterior chamber intraocular lenses) or AC-IOLs (anterior chamber intraocular lenses), however, Medicare won’t cover as much as it otherwise would.
Then, you may be on the hook for hundreds or thousands of dollars. That’s because you’re not using what it deems traditional surgical techniques.
Eye drops and antibiotics after cataract surgery will be covered by Medicare Part D with Original Medicare or by a Medicare Advantage plan from a private health insurer (Medicare Part C) that has prescription drug coverage. You may need eye drops daily for weeks after the surgery or much longer.
Cataract surgery coverage with Original Medicare vs. Medicare Advantage plans
Original Medicare lets you have the cataract surgery done by anyone accepting Medicare.
But Medicare Advantage plans typically require you to have the surgery through their in-network providers and facilities. You may owe a co-pay for the doctor and the facility where the surgery will be done. If you have a Medicare Advantage plan, check on its coverage rules before the surgery.
Medigap plans can cover some cataract surgery costs that Original Medicare doesn’t—like co-payments, co-insurance and deductibles.
Medicare will also cover any “medically necessary” post-surgery complications.
Does Medicare cover glasses after cataract surgery?
Medicare may also pay for 80% of the cost of prescription eyeglasses with standard frames or contact lenses if you purchase them from a supplier accepting Medicare assignment. That’s an exception to Medicare’s general rule of not covering glasses.
But not every retailer selling eyeglasses accepts Medicare assignment. Offering post-cataract surgery glasses and lenses “is probably not particularly appealing to a lot of optical shops because there’s paperwork,” says Glasser.
He recommends asking your eye doctor performing the cataract surgery for names of Medicare-approved locations.
If you want to get deluxe frames, progressive or tinted lenses or scratch-resistant coating for glasses after cataract surgery, however, you’ll need to pay those costs yourself—and those costs can add up.
Does Medicare cover combined cataract-glaucoma surgery?
If you have glaucoma and cataracts, the doctor may fix both problems during the surgery. But the traditional, fee-for-service Medicare program is currently debating whether to cover newer, less invasive glaucoma procedures, Glasser says.
