Does Medicare cover cataract surgery?

Cataracts can be a serious health concern as you age. While science has yet to isolate the true cause of cataracts, it has been proven that the breakdown of your eye lens proteins and other age-related changes do lead to cataracts. What are cataracts, exactly? Cataracts are characterized by clouding of the eye’s lens, which then becomes opaque and prevents light from reaching your retina. Symptoms include double vision, trouble with color perception, headlights, sunlight, and eventually even blindness. In fact, the World Health Organization says that cataracts are leading causing of blindness around the globe.

Cataracts may affect the central portion of your eye, the cortex around the center of your eye, or the back of your eye lens. Cataracts also may occur in both eyes.

While all of that sounds pretty dire, the good news is that cataract surgery is safe enough to be performed on an outpatient basis. In a nutshell, the surgical procedure replaces the deteriorating natural lens with a new artificial lens. If you have cataracts in both eyes, your doctor may opt to surgically repair one eye at a time. There are examples of vision improvements in both eyes after single-eye surgery.

Medicare Part B coverage

Medicare does cover cataract surgery. However, it only covers those expenses directly related to the cataract surgery procedure. Cataract surgery coverage falls under Medicare Part B, which handles the charges from your ophthalmologist and medical facility up to a certain approved amount. Typically you will need to pay Medicare Part B’s co-insurance fee (20%) in addition to your Part B deductible. Medicare usually covers standard replacement lenses, so if you and your doctor decide that you need specialized or upgraded replacement lenses, you will likely have to pay the difference out of pocket.

While cataract surgery is both common and usually successful, many patients require additional vision correction following the procedure. Though Medicare does not typically cover routine vision correction, it will cover contact lenses, intraocular lenses, and eyeglasses that may become necessary after your cataract surgery. Here again, Medicare Part B only covers standard frames and lenses. Any upgrades or designer eyeglass frames will likely not fall under Medicare’s approved coverage amount. Your lens or glasses supplier must also be enrolled in Medicare and possess a Medicare supplier number, otherwise your lenses or glasses will not be covered. As before, you will need to pay 20% of the Medicare-approved cost in addition to your Part B deductible.

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