Will Medicare cover cataract surgery in 2024?

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If you’re new to Medicare or planning different choices for the coming year, you may be wondering about certain coverage areas. For example, can Medicare help with eye health or cataract surgery?

Medicare—the federal health insurance program for people over age 65, as well as certain disabled people under age 65—can help you get this corrective surgery and any post-surgery vision care you need.

The importance of cataract surgery for vision health

Cataracts are common in the elderly. They develop when the proteins in your eye break down and cause the natural lens to cloud. This lens bends and refracts the light rays that enter the eye, so when it becomes cloudy, what you see can appear blurry—like looking through a fogged-up window.

Cataract symptoms may also include:

  • Blurred or double vision.
  • See less saturated colors. Lighter colors, for example, can appear yellow.
  • Sensitivity to light, especially headlights at night.
  • Difficulty seeing at night.

Cataracts can lead to blindness and can affect your safety as they develop. The good news is that they can be corrected with surgery.
During cataract surgery, your surgeon will remove the cloudy natural lens of the eye and replace it with a clear artificial lens. Called an intraocular lens, or IOL, this plastic device works just like your natural lens when it was clean.

Does Medicare cover cataract surgery?

  • part A. This part covers inpatient care in hospitals, skilled nursing care, and some home or hospice care.
  • Part B. This section focuses on services of doctors and health workers. Coverage includes outpatient care, physical therapy, various preventive services, and durable medical equipment, such as wheelchairs and walkers. Cataract surgery, which is usually performed on an outpatient basis, falls into this section.
  • Part C. Also called Medicare Advantage, this part includes plans offered by private companies approved by Medicare. These plans combine Part A, Part B, and usually Part D coverage into one plan.
  • Part D. This part is the prescription drug part of Medicare.
  • Medigap. This supplemental insurance includes “original Medicare” – Part A and Part B – and a coinsurance deductible plan.

“Many consumers don’t realize it, but Medicare covers cataract surgery in most cases,” says Bob Rees, vice president of Medicare sales and member loyalty at eHealth, Inc., a Santa Clara, Calif.-based health insurance broker and online resource provider.
Original Medicare doesn’t provide routine vision care, he adds, but it does cover cataract diagnosis and treatment, including traditional or laser surgery to correct the cataract with an IOL.

Please note: Medicare covers cataract surgery when it is deemed “medically necessary,” meaning that the cataract causes significant visual impairment. When corrective lenses and assistive devices are no longer sufficient for you to perform everyday tasks, then you have probably reached the threshold of medical necessity. Your ophthalmologist can advise you on this diagnosis.

Cataract surgery, as mentioned, is usually performed as an outpatient procedure. Medicare Part B covers the cost of surgery after you meet your deductible. (2024 annual deductible for all Medicare Part B enrollees it is $240.)

“This is a basic benefit provided by original Medicare, so it’s available to everyone,” explains Rees. “You do not have to be enrolled in a Medicare Supplement or Medicare Advantage plan to receive this benefit, although these products can help you save on out-of-pocket costs. Some Medicare Advantage (plans) also provide routine vision care.”

If you have a traditional Medicare Part B plan, you will be responsible for 20% of the cost of the surgery, after meeting the deductible. If you have a Medigap plan, you may be able to get additional coverage, either full or partial, for that 20%. Plans may vary, however, so be sure to read the fine print.

Types of lenses covered by Medicare

Medicare only covers standard cataract surgery that involves IOL implantation.

“Other forms of cataract surgery are usually not covered,” notes Rees.

Medicare also does not cover advanced technology lenses or surgeries that are considered elective, such as those to correct nearsightedness or astigmatism.

Eyeglass coverage after cataract surgery

After surgery, Medicare Part B will cover the cost of one pair of corrective glasses or contacts. Usually Medicare does not cover glasses or contact lenses, but for those who have had cataract surgery, this post-surgery treatment is an exception. However, you may have to pay some out-of-pocket costs.

“After you meet your Part B deductible, you can still pay 20% of the Medicare-approved amount for corrective lenses,” says Rees. “For glasses, coverage only extends to basic frames and lenses, so you can pay more if you get more stylish.”

Moreover, he notes, you must get said lenses from the right supplier.

“Medicare will only pay for your cataract surgery glasses or contact lenses from a Medicare-enrolled provider. It’s not enough for them to bill Medicare for you; they have to be Medicare-enrolled providers,” explains Rees.

Do Medicare Advantage plans cover cataract surgery?

Because coverage for cataract surgery is a basic Medicare benefit, you don’t need separate coverage for routine vision care.

However, some Medicare Advantage plans offer additional coverage for vision services.

Do I need additional insurance to cover cataract surgery?

You do not need additional insurance to cover cataract surgery. Medigap plans, however, can help you cover all out-of-pocket costs.

Cataract and lens surgery costs

Cataract surgery can be expensive depending on where you live and how the procedure is performed. However, Medicare sets an approved amount for the procedures it covers.

According to Medicare.gov’s Cost search tool, cataract surgery costs an average of $1,101. That amount is simply the facility fee and does not include the doctor’s fee. Your specific operation may involve additional steps, which may also increase costs.

Of the estimated $1,101 listed above, Medicare would pay $880, leaving $220 for the patient to reimburse out of pocket.

The surgeon’s fee can add significantly to this total. Generally speaking, cataract surgeries cost about $3,000 to $5,000 in total, depending on the complexity of the case, the doctor’s fee schedule, and the location where is the surgery is performed.

The key thing to remember here is that with an original Medicare Part B plan, you, the patient, will be responsible for 20% of the costs associated with the surgery, so make sure you understand in advance what your financial responsibility will be when scheduling your surgery.

Common Frequently Asked Questions: Medicare and Cataract Surgery

Here are some common questions Medicare beneficiaries ask when considering cataract surgery:

Does Medicare cover cataract surgery?

Yes. Medicare beneficiaries must first meet their annual deductible, which will be $240 in 2024, and pay 20% of the cost of cataract surgery. Medicare Part B covers 80% of the cost of surgery and post-surgical corrective lenses. A Medigap plan could help you cover the remaining 20% ​​of the costs you are responsible for paying.

What type of lenses does Medicare cover for cataract surgery?

Medicare covers the use of an IOL, a plastic artificial lens that replaces the natural lens that is clouded by cataracts.

Does Medicare cover laser cataract surgery?

Does Medicare cover multifocal lenses for cataract surgery?

Medicare only covers traditional cataract surgery procedures that involve IOL implantation. More technologically advanced devices are not covered under Medicare Part B, but if you have a Medigap or Medicare Advantage plan, your options may vary. Check your plan for details.

Does Medicare cover cataract surgery for people with astigmatism?

Medicare will cover cataract surgery for people who have astigmatism, as long as the surgery is considered medically necessary. Surgery will not resolve astigmatism; it will simply involve removing the clouded lens and replacing it with a clear, artificial lens.

Bottom line

Vision health is a key component of overall health and well-being, and you don’t have to accept blurred vision as just part of aging. Talk to your doctor about what you can do to get rid of cataracts, and check the details of your Medicare plan for more information for your specific situation.

If you need help understanding or navigating your Medicare benefits, visit Medicare.gov or contact the CMS Call Center at 1-800-Medicare.

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