Medicare is a federal health insurance program that covers certain medical expenses, including a portion of certain types of cataract surgery. Cataract surgery is a common procedure for those one Medicare that is used to remove clouded lenses in the eyes and replace them with artificial lenses.

Who pays for Medicare Eye Surgery explains who pays for Cataract Eye Surgery

In general, Medicare covers cataract surgery as long as it is deemed medically necessary. The patient must have a doctor’s order for the surgery and the procedure must be performed by a Medicare-approved provider.

Medicare Part B (Medical Insurance) covers the surgical removal of cataracts, including the use of a microscope, the cost of the intraocular lens (IOL) as well as the surgeon’s fee.

Medicare Part B also covers one pair of eyeglasses or contact lenses with standard frames after surgery if the patient had cataract surgery on one or both eyes and the provider thinks that the patient needs the glasses or contact lenses to achieve the best result from the surgery.

If you choose to have a lens other than the standard one, like a multifocal or accommodating lens, it’s NOT covered by Original Medicare. The patient would have to pay the full cost of the procedure.

How much will someone on Medicare pay for Cataract Surgery?

It’s important to note that with most procedures under Medicare, the patient will generally have to pay a portion of the cost, called a coinsurance, as well as any deductibles. Many Medicare recipients who have cataract surgery are required to pay $226 Part B deductible and 20% of the procedure. According to Nerdwallet the national average for Cataract surgery on one eye was $2,627 in 2022. If the deductible was previously satisfied then $525.40 (20%) would be passed on to the patent

It is important to check with your provider and review the total cost of the procedure before scheduling the surgery to know what expenses you may have to pay out of pocket.

Can you get help paying for Cataract Surgery?

Yes. Since Medigap plans help supplement Medicare, they can pay for Medicare fees usually passed on to the patient. Those with Medigap plan G would still pay the Part B deductible but would not have to pay the 20% coinsurance ($525.40 in the example illustrated above). If you are interested in learning more about how to purchase Medigap, please visit our Medigap overview page or get a quote by clicking the button below.

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Medicare Advantage plans all include some coverage for cataract surgery. However, the level of coverage and your out-of-pocket costs will depend on the type of plan you are enrolled in.