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Cataract surgery is one of the most commonly performed surgeries in the world! The American Society of Cataract and Refractive Surgery estimates that over 3.5 million people undergo cataract surgery in the U.S. each year. It is also one of the most successful surgeries, with 9 out of 10 people experiencing improved vision after the surgery. With so many people undergoing cataract surgery since it is the only way to fix cataracts, it makes sense that Medicare would cover the surgery. However, it can be confusing to uncover what is covered and what isn’t! Does medicare cover cataract surgery and lens implant? Does Medicare cover cataract surgery for seniors? We’ll break down the different types of Medicare and what they cover to make it easy for you to get the surgery you need using Medicare.
What Is Cataract Surgery?
Cataract surgery is the process of removing cataracts from the eye and replacing the damaged lens with a new, artificial lens. The procedure is quick and relatively painless, with advances in technology making it an outpatient procedure, meaning you can get back to your daily life fast.
Cataracts form as the protein structures in the eye begin to breakdown as we age. With nowhere to go, the proteins begin to accumulate in the lens, leading to cloudy, blurry vision, and eventually blindness. The only way to correct cataracts is through surgery. During the surgery, the surgeon will make an incision to access the cataract, which is then broken up and removed. Once the cataract has been removed, the surgeon will place an artificial lens known as an intraocular lens (IOL), allowing you to see clearly. Some patients may choose a premium IOL to help correct for vision problems, but these are generally not covered by Medicare.
Following cataract surgery, you will have a short recovery period during which your eyes will adjust to the new lenses. It is important to follow the aftercare instructions provided by your surgeon and attend all follow-up appointments to prevent infection or problems with the new lens. If you’d like to speak to a cataract surgeon, call the nearest OCLI Vision office today to schedule a consultation.
Does Medicare Cover Cataract Surgery?
It depends. The Medicare requirements for cataract surgery include coverage for patients whose doctor has declared it medically necessary, depending on where you live. A medically necessary designation means that the cataracts are negatively impacting the patient’s daily life and must be removed through cataract surgery in order to restore eyesight. However, even when covered, the patient may still be responsible for out-of-pocket costs associated with the procedure.
For example, with Medicare Part B, the following stipulations apply for the patient’s costs, according to Medicare:
- “For covered cataract surgery in a hospital outpatient setting or ambulatory surgical center: After you meet the Part B deductible ($257 in 2025), you pay 20% of the Medicare-approved amount to both the facility and the doctor who performs your surgery.”
- “For covered cataract surgery you get in a doctor’s office: After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for both the intraocular lens and the surgery to implant it.”
In addition to cataract surgery, Medicare Part B will pay for a set of glasses or contact lenses after the procedure. These are usually not covered by Medicare. It is important to note that Medicare Part B will not cover premium IOLs or additional elective surgery to correct nearsightedness or farsightedness.
However, there are Medicare supplement policies available that may reduce out-of-pockets costs and provide for premium IOLs.
What Is Medicare Part A?
There are different parts to Medicare, which is federal health insurance offered to people 65 years old and above. Medicare Part A is designated for inpatient care in different facilities, including hospitals, critical access hospitals, and skilled nursing facilities. At times it will also cover hospice care and some home health care, but it will depend on many factors. Generally, Medicare Part A will not be used for cataract surgery.
Does Medicare Part B Cover Cataract Surgery?
Medicare Part B, or medical insurance, is the part of Original Medicare that covers cataract surgery, depending on the patient’s location. The plan also covers other medical services to diagnose and treat medical conditions, as well as preventative care services such as wellness checkups and other services to prevent or catch illnesses early.
What Is Part C Medicare?
Medicare Part C, is also known as Medicare Advantage. With Medicare Advantage, private insurance companies bundle the coverage from Part A and B and provide insurance plans. Most of these plans also include Part D which is prescription drug coverage. These private plans have different coverage and may provide services or benefits that Original Medicare does not. All plans will have different out-of-pocket costs and deductibles, so it’s important to understand what you’re getting with Medicare Advantage plans vs Original Medicare.
Does United Healthcare Cover Cataract Surgery?
Generally, United Healthcare covers cataract surgery. However, it is very important to confirm coverage with your specific plan to clearly understand your deductible, out-of-pocket costs, copays, and coinsurance. United Healthcare provides a variety of Medicare Advantage plans that will cover cataract surgery, but some of them may require prior authorization before providing coverage. Each plan will be unique to the individual, so it is vital to contact United Healthcare before undergoing cataract surgery to ensure it is covered. Additionally, many patients wonder, ‘does Humana cover cataract surgery? It’s best to call your insurance company if you have questions about your converge.
How Much Is Cataract Surgery?
The cost for cataract surgery depends on many factors, including location, type of procedure, type of lens implanted, insurance coverage, and more. The average cost of cataract surgery with Medicare will also vary by region and plan, plus any supplement or private plans. However, the team at OCLI Vision will work with you and your insurance company to ensure you get the maximum coverage possible. We believe that cataract surgery is an important procedure and has the ability to improve the lives of countless individuals suffering from the cloudy vision of cataracts. Contact the OCLI Vision office nearest you to schedule a consultation and receive an estimate for cataract surgery.
Cataract surgery is the only way to correct cataracts and start seeing clearly again. The ophthalmologists at OCLI Vision are some of the best in the country for performing cataract surgery, so schedule a consultation today.
