Does Medicare Cover Cataract Surgery? Get Clarity Today

Seniors with cataracts will be pleased to learn that Medicare does indeed cover cataract surgery, including necessary follow-up care for a smooth recovery. Since this is an outpatient surgery, the procedure is covered by the Medicare B Plan. Not only does Medicare cover cataract surgery, but seniors can work with a Medicare Planning Expert to find additional Medicare coverage that can assist with costs and prescriptions.

The risk of cataracts increases sharply with age, with the National Eye Institute reporting that over 50% of U.S. adults over the age of 80 have cataracts or have received surgery for cataracts. The right Medicare planning can help reduce the stress and anxiety associated with cataract surgery, ensuring costs and recovery are adequately covered.

Learn more about Medicare policies that can assist with your cataract surgery cost, including important information about conditions, procedures, and recovery.

What Are Cataracts?

Having a solid understanding of cataracts demystifies the condition, making the road to surgery and Medicare planning easier. Discuss the condition thoroughly with your doctor, including additional needs for IOL implantation, which is an intraocular lens.

A cataract refers to the clouding of your eye’s natural lens. It’s a vital part of the eye that’s responsible for focusing light to produce sharp images.

What Causes Cataracts?

Cataracts are often age-related, but they can occur from an injury or certain diseases, like diabetes or hyperthyroidism. As you age, the proteins within your eye lens naturally start to break down and clump together, leading to cloudiness.

Talk to your doctor about any long-term medications you’ve been taking, as prolonged steroid use has also been linked to posterior subcapsular cataracts, according to data from Healthline. Other factors that can lead to cataracts include:

Glaucoma
Retinal detachment
Uveitis (inflammation of the middle layer of the eye)

Even nutritional deficiencies, such as a lack of Vitamin A, E, and C, can increase the risk of cataracts, with the American Optometric Association citing research that increased levels of these vitamins, including essential fatty acids, can help lower the risk.

What Are the Symptoms of Cataracts?

The most noticeable symptom is blurred and hazy vision caused by the clouding. Your vision may also appear dimmed.

Increased light sensitivity is common with this condition. You may notice “halos” forming around lights. Fading colors is another symptom, as well as worsening vision at night.

What Can You Expect From Cataract Surgery?

During cataract surgery, your surgeon will remove the clouded natural lens and replace it with an artificial lens called an Intraocular Lens (IOL).

Before surgery, your eye is numbed with local anesthetic eye drops. Your surgeon can also administer a mild sedative to help you relax throughout the procedure.

Your surgeon will make a tiny incision in the cornea of your eye, using a femtosecond laser if you’re getting laser-assisted cataract surgery. Next, the surgeon will use an ultrasound device or laser to break down the clouded areas into smaller pieces before gently extracting them from your eye.

The new IOL is carefully inserted through the incision. Rest assured, this lens will be designed to meet your vision needs.

Which Medicare Insurance Covers Cataract Surgery?

Since cataract surgery is considered medically necessary, it’s covered by the Medicare program. The surgery is also an outpatient procedure, so it’s specifically covered under Medicare Part B insurance.

Medicare Part B covers the cataract surgery itself, which includes both the cataract removal and the standard (monofocal) Intraocular Lens (IOL) implantation. Your Medicare insurance covers the following service fees:

Surgeon’s fees
Anesthesia fees
Medical facility fees

Medicare Part B also covers post-surgery care like medically necessary follow-up appointments. You’ll receive prescription eyeglasses. You may also opt for contact lenses after surgery.

Do You Have to Pay Out-of-Pocket Costs for Cataract Surgery?

It’s important to remember that you must meet your annual Medicare Part B deductible before coverage begins. After meeting this requirement, you’re expected to pay a 20% coinsurance cost; this is 20% of the approved Medicare cost for the surgery and medically necessary services, including post-surgery care.

You’re also responsible for paying the difference on upgraded IOL lenses that aren’t covered by Medicare insurance. For example, Medicare B will cover standard monofocal lenses, but you will have to pay the difference on multifocal upgrades.

Standard versus upgraded IOLs can be a point of confusion, especially when it comes to estimating Medicare costs.

The standard IOLs for cataract surgery are monofocal IOLs that correct vision for a single distance. These are fully covered by Medicare Part B.

However, multifocal IOLs (for extended depth of focus) are considered an elective surgery enhancement, which requires out-of-pocket costs. If you want Toric IOLs to correct an astigmatism, you’ll also have to pay out-of-pocket expenses.

How Does Medicare Coverage Work for Cataract Surgery?

Let’s start with Medicare Part B; this is your original, baseline Medicare coverage. The out-of-pocket costs associated with this coverage are your 20% coinsurance for the approved surgery cost and the Part B deductible.

There is also the Medicare Advantage Part C plan. This coverage comes with the same Medicare health benefits as Part B, including cataract surgery coverage for standard IOLs. However, under the Medicare Advantage plan, you can only work with in-network health providers.

You will have to review your plan’s specific coinsurance costs, copayments, and annual maximum caps for out-of-pocket costs. Reviewing this information with a Medicare Planning Expert can help you gain a clearer picture, even leading you to a more cost-effective plan.

Can You Use Medigap for Cataract Surgery?

Medigap is a Medicare supplement policy. Yes, you can use your Medigap policy to help pay for expenses associated with your Medicare Part B Deductible and the 20% coinsurance amount. However, your Medigap policy cannot cover the costs of a premium (upgraded) IOL lens.

What Can You Expect from Cataract Surgery Recovery?

Fortunately, cataract surgery is a self-healing procedure with a generally fast recovery timeline. You can make a full recovery within two to six weeks. You’ll also experience a noticeable vision improvement within the first 48 hours.

Your surgeon will advise you to:

Rest during your recovery
Wear a protective shield over your eyes
Wear sunglasses (if you go outside)
Use prescription eye drops
Not drive
Avoid bending down or lifting heavy objects
Avoid eye irritants
Contact the doctor if vision worsens

After a week, you may resume light daily activities. However, you’ll be advised to avoid strenuous activities that could expose the eye to debris or water.

By week six, you should be able to return to your daily routine. Your vision will be fully stabilized by then. A medically necessary final eyeglasses prescription will also be provided and covered under Medicare.

Does Medicare Cover Cataract Surgery Recovery?

Yes, Medicare Part B (and the Advantage Plan) covers medically necessary services for recovery, such as follow-up appointments with an ophthalmologist for a defined period.

Medicare also covers prescription glasses (or contacts) to wear after the surgery. Patients pay 20% of the Medicare-approved amount for prescription eyewear after the Part B deductible, but Medigap policies may be used to assist with costs.

Any prescribed medications, like eyedrops or antibiotics, are covered under Medicare Part D coverage for prescription drugs. Medicare Advantage also has prescription drug coverage.

Frequently Asked Questions

How Can a Medicare Planning Expert Help With Cataract Surgery?

The logistics of Medicare can be quite overwhelming, especially if you’re already dealing with the stress of having cataracts and needing surgery. A Medicare Planning Expert can help you navigate the following:

Costs
Deductibles
Coinsurance amounts
Different Medicare Plans

An expert can help guide you toward policy decisions and vision care insurance that won’t strain your finances.

How Can a Professional Assist With Medicare Planning?

A Medicare Planning Expert also makes tailored policy recommendations that support seniors’ broader long-term health needs and objectives.

With this level of insight, you don’t have to limit your eye health coverage to protect your retirement.

What Is the Process of Working With a Medicare Planning Expert?

Medical Planning Experts are trained in breaking down complex Medicare topics into manageable steps that are easy to understand. Demystifying Medicare policies is the first step toward building trust, leading to more cost-effective policy recommendations that meet seniors’ needs.

Having an expert explain the details of out-of-pocket expenses and how to leverage Medigap is invaluable to long-term savings.

Working with a trained expert can lead to more accurate cost planning, using foresight to avoid surprise costs.

Get the Medicare Planning You Need for Cataract Surgery

Don’t let Medicare confusion heap more stress onto your plate. Not only does Medicare cover cataract surgery, but the right planning strategy will also free you up to focus on a full recovery. Consult with your doctor on the best course of treatment, and work with a real Medicare Planning Expert who can recommend policy planning that supports the bigger picture, your long-term health.

Key2Medicare is an insurance brokerage agency with over 30 years of experience in guiding seniors and retirees toward smart Medicare decisions. Our experience gives us a unique edge in recommending Medicare decisions that support broader health goals and needs.