Does Medicare Cover Cataract Surgery?

Find out if Medicare covers Cataract surgery

by Katie Banks+ on Jul 05, 2016 | 21 Comments

Cataracts are when the lens of the eye becomes cloudy, resulting in blurry vision. This condition worsens with age, and can be very uncomfortable. There is surgery available, but since Original Medicare does not cover most general eye care, many wonder does Medicare cover cataract surgery?

Does Medicare Cover Cataract Surgery?

Original Medicare does cover cataract surgery*. That’s good news, but what does it cost?  It can be a little complicated. We’ll explain below.

*Your doctor may recommend you get services that Medicare does not cover, as well as, they may recommend services more frequently than Medicare covers. If this is the case, you may be required to part or all of the costs.

How Much Does Cataract Surgery Cost?

Like we said, Medicare’s coverage of cataract surgery can be complicated. Since cataract surgery can be done both as inpatient and outpatient surgery, as well as every patient has specific surgical needs, and aftercare varies, there isn’t a hard and fast cost breakdown. See, when we say complicated, we aren’t lying. However, if you have certain Medigap plans you won’t need to worry about the out of pocket costs. I’ll explain below.

Does Medigap Cover Cataract Surgery?

Medigap plans do cover cataract surgery. Remember, Medigap plans fill in the gaps of Original Medicare, so some plans will cover more than others. If you think you might need cataract surgery, you would want to compare Medigap plans. To eliminate costs, you would want to choose one that covers both your Part A and B deductible, as well as your copays and coinsurance, such as Medigap “C” or “F”.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Cataract Surgery?

Yes, Medicare Advantage does cover cataract surgery. But to add to the confusion, one of the cons of Medicare Advantage is they vary in coverage, therefore each plan can cover the surgery differently AND does not need to offer the same coverage as Original Medicare.

Learn More about Medicare Advantage Get a MA Quote


To learn more about what Medicare covers call a Senior65 agent 800-930-7956.

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Reader Comments and Questions

By James on June 30, 2019

My vision is currently 20/30 in both eyes - but have issues with cataracts. Does Medicare cover cataract surgery under these conditions or does my vision have to worsen for coverage? I have Medicare parts A and B.

James,
You should contact Medicare directly with this question because like we said in the article, Medicare coverage in this area varies.
-Chris from Senior65.com


By David on June 11, 2019

I have Medigap Plan F, I have cataract surgery in the morning caused by dual retina detachment 15 years ago. I require a Toric IOL. Clinic says I owe $900 for the Toric. Shouldn’t plan F pay the $900?

David,
Generally the additional costs related to an astigmatic correcting IOL (toric IOL) are not covered by insurance. You should check with your plan to see if they cover it. If Senior65 is assigned as your insurance agent, please contact us and we can assist you with this process.
-Chris from Senior65.com


By Helen on May 02, 2019

Would like to know how much I will have to pay on Cataract Surgery. I am unable to find out. I have the Medicare Advantage Plan.

Helen,
Each Medicare Advantage plan varies on if and how they cover cataract surgery. If we are listed as your agent, give us a call and we can explain how your plan works. If you did not enroll through a Senior65 agent, you will have to check with your insurance plan directly.
-Eric from Senior65.com


By Gary on February 09, 2019

Dear Gentlemen: How much does united healthcare Advantage pay for outpatient cataract surgery in part B and how much is each medigap premium and their respective percentages they pay of part B deductibles and payments??? Thankyou, Gary

Hello Gary,
Benefits for Medicare Advantage (MA) plans vary from county to county so we are unable to post up specific coverage information here. Since Medigap plans are standardized you can receive instant price and coverage information on our Medigap Quote Page.

If you currently have an MA plan, give the insurance provider a call to get specific cataract coverage details. If you are in the market for a new MA plan, we can help you select a plan that matches your specific needs. Give us a call and we can go over it on the phone.

-Michelle from Senior65.com


By Walter on February 05, 2019

I wonder what coverage I ave for cataeact surgery, I have plan K.on top of my medicare

Hello Walter,
Medicare may cover your cataract surgery if your doctor recommends it as medically necessary.

You will still be subject to Medicare deductibles and copays. Check out our Medigap plan K page to see exactly how plan K handles Medicare deductibles and copays.

-Chris from Senior65.com


By Andrea on January 19, 2019

I have medicare (A&B) also supplement F. (need several surgeries; appeared to be good plan but for nearly 5 years I have yet to use it for my impending surgeries)-Just found I need cataract surgery and keep hearing people tell me it costs x or y for the lens of each eye plus more if you have any eye problems. Waiting on app't. now; trying to get an idea of my potential out-of-pocket costs. I barely make it from mom. to mon. so naturally very worried.

Hi Andrea,
If you have a Medigap Plan F, it will cover costs associated with surgeries including cataract. If we are listed as your agent, please call us so we can help you. If we are not, please call your agent or the insurance company directly.

As you know, independent licensed insurance agents are here to help you at no additional cost, so be sure to take advantage of that resource.

-Chris from Senior65.com


By Dar on July 20, 2017

I am scheduled for cataract surgery and got the bill of $1405 for Crystalens and $795 for the eye surgeon. Is the eye surgeon's fee covered by medicare? I have plan F.

Dar,
If you have Medigap Plan F, you should have no out of pocket expenses, as long as Original Medicare covers it. You will need to contact Original Medicare for specific details on whether or not your surgeon accepts assignment, and if Crystalens are covered. If your surgeon does not accept assignment, you can be charged excess charges, which you will pay upfront, then Medigap F should pay you back.
-Chris from https://www.senior65.com/


By Theresa on May 24, 2017

I have medicare advantage plan and champ va. How much will they cover catarac surgery ane lens replacement for astigmatism for each eye which will be multifocal lens?

Theresa,
You will want to contact your providers to learn how it will be covered. If you are looking to change Medicare Advantage providers during Open Enrollment call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Sammy on May 19, 2017

After cataract surgery will Medigap Plan G pay the difference of glasses?

Sammy,
If Original Medicare covers your glasses, then Medigap Plan G will pay the difference, but only after you pay the Part B deductible. If you need help finding the right Plan G for you, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Irene eskue on February 16, 2017

Does original Medicare pay for Toric lensx implant?

Irene,
While Medicare covers cataract surgery, you will need to speak to your doctor and Medicare about specific services.
-Chris from https://www.senior65.com/


By Robyn Carr on October 30, 2016

My husband and I have Medigap plan"G" does that cover any expenses for cataract surgery?

Robyn,
Medigap Plan G will cover the costs of cataract surgery after Medicare pays its part, with the exception of the Part B deductible, and with all Medicare plans, if Original Medicare doesn't cover the cost, you pay 100%.
-Amy from https://www.senior65.com/


By Vickie on May 20, 2016

I have Champ VA and medicare part a and b. Do you know how much out of pocket for me to have cataract surgery?

Vickie,
Unfortunately, we are not VA experts and cannot sell ChampVA plans. You'll want to contact your insurance provider for ChampVA to find out your out of pocket costs (the number should be on the back of your card) or go online to get a summary of their benefits. Best of luck!
-Amy from https://www.senior65.com/


By Eileen Chadwick on April 06, 2016

I'm 75, on Medicare with Tricare as secondary insurance. I'm in the early stages of cataracts and wonder whether the condition has to reach a certain stage before Medicare will cover expenses or whether I can have the surgery early before it gets worse. Also does Tricare pick up expenses not covered by Medicare? Thank you.

Eileen,
To learn how Medicare approves treatment and surgery, you will want to contact Medicare directly. As for Tricare, we are not VA experts, but it appears that you will still have out of pocket costs. You will want to contact your Tricare provider to learn more about your coverage through them.
-Amy from https://www.senior65.com/


By Tracy Reynolds on April 06, 2016

I need to have Cateract surgery soon. I am enrolled in Medicare plan N. Does this plan cover my surgery?

Tracy,
Medigap Plan N will cover most of the costs of your cataract surgery; however, you will have to pay your Part B deductible and copays, and you can pay excess charges if you see a doctor that does not accept Medicare assignment. If you would like to look into a plan that covers these costs, call one of our licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Kelly on March 22, 2016

I need cataract surgery. But I have bad astigmatism. I believe I will need a toric lens (astigmatism IOL). with my cataract surgery. Does Medigap cover this extra lens procedure along with my cataract. I do not believe Medicare Advantage does not. They just cover regular cataract surgery

Kelly,
Since cataract surgery is different for each individual, you'll want to check with your doctor to see if Original Medicare covers your specific lens. If it does, then your Medigap policy can pay all or part of the remainder of the costs. If you need help finding a Medigap plan, please call one of our licensed independent insurance agents at 800-930-7956.
-Eric from https://www.senior65.com/


By Adella Andrade on February 10, 2016

i have Medicare A only and I need to have Cateract Surgery! What plan would I need to cover all my expenses and not out of pocket cost I'm receiving social security my only means of income.

Adella,
While Medicare Part A covers hospitalization, your Part B coverage covers your doctors and surgeons. We suggest adding Part B. If you are outside of your Medicare initial enrollment period, you can join during the Part B General Election period, if this is your case, remember Part B won't start covering you until July 1. While Medicare parts will have you partially covered, they could leave you with some hefty bills. We suggest you apply for Medigap plan to fill in the gaps, if you are not approved, or it is not in your budget, and you are still within your initial enrollment period, you should apply for a Medicare Advantage plan. Hope this helps!
-Eric from https://www.senior65.com/


By Le on January 27, 2016

Trying to help a lady from church find assistance with paying for cataract surgery. She has Medicare part A only. She is on oxygen full time. Any suggestions? Thank you.

Le,
She may want to apply for Medicare Part B and apply for Medigap or Medicare Advantage to help cover the extra costs. Remember she needs to apply for Part B between now and March 31st for a July 1 effective date.
-Amy from https://www.senior65.com/


By Chris on November 26, 2015

Hi, If i have Cigna HealthSpring hmo-pos, and about to have a cataract removed, can you tell me how much to expect to have to pay out of pocket please? I already had to pay $40 co-pay for my first visit with the surgeon, and another $40 for the second visit (the pre-op appt.) I thought the pre-op was no co-pay from what i have read, but they said something about having to do an e-test so there was a co-pay? Anyway Just wanting to make sure those charges were justifiable and how much i will owe after the surgery? Thanks for your time, Chris

Chris,
You'll want to contact Cigna directly to get your specific answer about cataract surgery. They will be able to detail this all for you. Wish we could give you a better answer.
-Eric from https://www.senior65.com/


By Igor on June 30, 2015

I'm new to Medicare, just turned 65 last month, and I'm supposed to have cataract surgery in the next year. I've been weighing enrolling if I should just have Original Medicare or Med and Medigap, or go with Medicare Advantage. Which do you think will be the bigger savings, since I'm healthy besides the surgery.

Igor,
If you can afford Medigap, that is our suggestion, because if you get a plan like Medigap Plan F, you generally have no out of pocket costs after your premium. This usually makes it easier to plan for the rest of the year. If you cannot afford Medigap, Medicare Advantage caps your spending each year. So that would be a good option, as well.
-Chris from https://www.senior65.com/


By Tanya Prinze on June 18, 2015

Do you think Medicare Advantage or Medigap will cover more of your cataract surgery cost?

Tanya,
More than likely a Medigap plan, like Medigap Plan F, which would cover all of your out of pocket costs, would cover more than a Medicare Advantage plan, because generally they can have deductibles, copays, and coinsurance. Hope this helps.
-Chris from https://www.senior65.com/


By Michael Morford on June 17, 2015

Looks like Medigap is the way to go. Which Plan do you suggest?

Michael,
We suggest Medigap Plan F, because it covers the most. For some people the monthly premium may be too expensive, if that is true, C, G, and N, are also really great options. But call us at 800-930-7956 and we can help you find the right plan for you.
-Eric from https://www.senior65.com/



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