Does Medicare Cover Cataract Surgery?
May 3, 2023 | Marcia Pruitt
According to the National Eye Institute (NEI), more than half of older Americans either have cataracts or have undergone surgery to get rid of them. With these statistics, you or someone you know will deal with cataracts in their senior years. Surgery has come a long way in the past few decades, and many individuals will elect to have surgery to remove cataracts. If you find yourself or a loved one needing cataract surgery, you will want to know how it is covered by Medicare and your health insurance.
What are Cataracts?
Cataracts are an eye condition where the eye’s lens becomes cloudy, leading to decreased vision. The eye lens usually is clear and helps to focus light allowing us to see clearly. The lens may break down as we age, resulting in a cataract. An eye injury to the eye, certain medications, or medical conditions such as diabetes may also cause cataracts.
Symptoms of cataracts may include:
- Blurred vision
- Double vision
- Faded colors
- Sensitivity to light
- Difficulty seeing at night
- Seeing halos around lights
Read: How Often Should Seniors Get Vision Screenings
Treatment for Cataracts
In the early onset of cataracts, they may be treatable with changes in eyeglasses prescription and other treatments. When cataracts become more prominent, they can typically be treated by removing the cloudy lens by means of surgery. Your doctor will work with you to determine what approach will result in the best outcome based on your condition.
How Does Medicare Cover Cataract Surgery?
Original Medicare does cover cataract surgery. With Original Medicare you can anticipate a deductible and co-insurance of 20% for your surgery costs.
Although Medicare does not typically cover prescription eyeglasses or contact lenses, following cataract surgery, medicare will help to cover the cost of corrective lenses or standard frame eyeglasses. It is important to note that the supplier must accept Medicare assignment.
If you have additional coverage beyond Original Medicare, such as a Medicare Advantage plan or a Medigap policy, then your patient responsibility will vary depending on your specific plan’s terms and coverage. If you need help determining what your plan covers, you can contact us for assistance with your Medicare plan coverage.
Read: Does Your Medicare Advantage Plan Offer Extra Benefits
In addition to your Medicare plan type, other factors that can influence your out-of-pocket cost include where you have your surgery (hospital vs clinic setting) and the type of corrective surgery needed.
If you have questions on how your plan may cover a potential surgery, it can be helpful to contact your Medicare health insurance carrier for coverage details. By working with an experienced Medicare professional, you can have peace of mind that your Medicare plan provides the coverage you need. Contact us today with your Medicare questions.
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