While Original Medicare generally does not pay for routine eye care, Medicare cataract surgery coverage is offered to beneficiaries with chronic eye conditions.
With aging comes the risk of developing cataracts, cloudy areas in the lens of the eye that can greatly affect vision. Symptoms include blurry vision, sensitivity to glare, poor night vision, and/or frequent prescription changes in eyeglasses or contact lenses. While cataracts can develop at any age, this condition is common for older individuals, including many who are already enrolled in the Medicare program. By the age of 80, more than half of all Americans have either had a cataract or had cataract surgery, according to the National Eye Institute. Thankfully, Medicare will cover medically-necessary surgical procedures, such as cataract surgery.
When is cataract surgery necessary?
Early cataracts can be improved with new eyeglasses, magnifying lenses, and anti-glare sunglasses to name a few; however, these will only help the situation rather than treat it. Surgery to remove the cloudy lens and replace it with an artificial intraocular lens is the only effective treatment of cataracts.
While not all people with cataracts need surgery, surgery may be the best option when vision loss interferes with your everyday life, such as reading, driving, or watching television. Even if a cataract does not cause any issues, its removal may still be necessary if it presents the examination or treatment of other eye problems.
Before choosing to undergo cataract surgery, you should talk with your doctor about whether surgery is right for you, particularly if you have other eye conditions. It is important to understand the risks and benefits before opting for surgery.
How does Medicare cover cataract surgery?
Medicare does cover cataract surgery when it is medically necessary as the procedure is performed by an ophthalmologist, or physician, rather than an optometrist. Medicare Part B will cover the surgery, intraocular lens implants, and one pair of eyeglasses with standard frames or one set of contacts following surgery, provided that it is obtained from a Medicare-approved supplier. Medicare will also cover a pre-surgery exam, as well as anesthesia during the surgery. For those who opt to get cataract surgery, but no lens implant, Medicare will consider coverage of certain bifocals and other supplies.
It is important to get services and supplies through health care providers who accept Medicare otherwise it may not be covered. Medicare only pays for expenses directly related to the treatment of cataracts; any other procedures performed at the same time of surgery will be billed separately.
You will be responsible for paying for your share of the expenses, unless you have other private insurance coverage. For both the cataract surgery and the glasses, you are responsible for paying 20% of the Medicare-approved amount in addition to your Medicare Part B annual deductible, which must be paid before Medicare pays for its share of any eligible services and supplies. If you choose a pair of eyeglasses that are not fully covered by Medicare, or if you decide to get a special enhanced type of intraocular lens instead of the standard lens, you are responsible for paying the difference yourself in addition to the 20% Part B coinsurance.
Visit eHealth Medicare for more information on Medicare and cataracts.
Medicare has neither reviewed nor endorsed this information.