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Dear Connie,
I’ve used glasses for nearly my entire life, but recently, I’ve found my vision deteriorating. My vision is blurry, hazy, and less colorful, and I am also having more trouble reading.
I’ve researched online, and I think I may have developed cataracts. I’m wondering, does Medicare cover cataract surgery?
Worried about my vision,
Sharon from Fort Lauderdale, Florida
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Local, licensed insurance agents with 25+ years of experienceDear Sharon,
We’re happy you contacted us with your question because this issue impacts many people.
One in five Americans aged 65 to 74 has cataracts that affect their vision. More than 50% of Americans aged 80 or older have cataracts or have had surgery to remove them.
Cataracts are the leading cause of vision loss in the United States. Nearly everyone experiences vision change as they age, and most cataracts are age-related. In some cases, they can also develop after an eye injury or glaucoma, but you didn’t mention those.
A cataract can occur in one or both eyes and cloud the usually clear eye lens. The vision of someone with a cataract is blurry, like looking through a fogged-up window. This clouded vision can make it hard to read, drive a car at night, or see expressions on faces.
While your symptoms might be mild at first, as cataracts grow – and they do – they can cause more severe changes to your vision. These changes could include:
If you have any of these vision changes, you should see your eye doctor to check your vision. Your ophthalmologist will perform a simple and painless dilated eye exam (slit lamp exam) and or a visual acuity exam to check for cataracts and other eye problems.
This is of the utmost importance. If you don’t have your eyes checked and have cataracts or another eye problem, you risk vision loss. So, we’re really happy you’re being proactive and asking questions.
Agent tip:
“Original Medicare may cover 80% of a traditional cataract surgery. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.“
If your eye exam reveals a cataract or two, cataract surgery is the only way to restore clear vision. During the surgery, an ophthalmologist removes the clouded natural lens and replaces it with an intraocular lens (IOL), an artificial lens that stays in your eye permanently. Another benefit of cataract surgery is that it may correct refractive errors, allowing you to rely less on glasses or contacts after surgery. So, the question is … does Medicare cover cataract surgery?
Original Medicare helps cover part of cataract surgery, and Original Medicare Part B covers traditional intraocular lenses. If you get cataract surgery in an outpatient hospital, ambulatory surgical center, or doctor’s office, you pay the Medicare Part B deductible plus 20% of the Medicare-approved amount.
The average cost of cataract surgery is $3,500 per eye. If you have Original Medicare only, you would pay the Part B deductible plus the $700 coinsurance per eye.
If you want a more advanced treatment like laser or New Technology Intraocular Lenses (NTIOLS), you may be required to cover more than 20% or even all of the cost. Laser-assisted cataract surgery or procedures with advanced lens implants can cost between $4,000 and $6,000 per eye.
Original Medicare may not cover multifocal or toric lenses, but it will cover mono-focal lenses. You should check with your ophthalmologist and doctor to discover their recommended procedure.
If you’re worried about the out-of-pocket costs for your vision exam and potential cataract surgery, two types of plans can help: Medicare Supplement or Medicare Advantage.
A Medicare Supplement (Medigap) plan helps cover some or all out-of-pocket costs that Original Medicare doesn’t cover. For example, it would cover 20% of the coinsurance for cataract surgery.
Free, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of experienceA Medicare Advantage plan provides equal coverage to Original Medicare and has extra benefits such as vision, dental, and hearing, plus better coverage in many instances. In most cases, it would cover the entire cost of cataract surgery plus the vision appointments leading up to it. A Medicare Advantage plan may also cover laser or New Technology Intraocular Lenses (NTIOLS).
A Medicare Advantage plan is available starting at a $0 monthly premium and often comes with benefits that you can’t get with Original Medicare or a Medigap plan. If you want vision coverage, this might be the most cost-effective option.
I hope this information helps you determine your next steps. We recommend that you see your eye doctor first.
If you’d like Medicare to cover your eye exam, a local licensed Connie Health agent can review Medicare Advantage plans in your area that offer that benefit, plus coverage for cataract surgery. When you call an agent, inform them about the benefits, doctors, or hospital networks that are important to you.
If you’re already enrolled in a Medicare Advantage plan, you can check your Evidence of Coverage (EOC) to see if your plan covers eye exams and cataract surgery. You can also review your coverage with your plan provider or a Connie Health agent.
At Connie Health, we help you throughout your Medicare journey. For additional coverage questions, contact a local licensed Connie Health agent at (623) 223-8884 for help.
Original Medicare covers mono-focal lenses for cataract surgery. However, it may not cover multifocal or toric lenses. Therefore, you should check with your ophthalmologist and doctor for their recommended procedure.
Original Medicare Part B covers mono-focal and traditional intraocular lenses. After the Medicare Part B deductible is paid, you would be responsible for 20% coinsurance of the Medicare-approved amount and medications.
Medicare Advantage plans provide equal coverage to Original Medicare. They will cover mono-focal lenses and may cover multifocal or toric lenses. These plans may also provide greater coverage for cataract surgery, such as laser or New Technology Intraocular Lenses (NTIOLS).
A local licensed Connie Health agent can help you review Medicare Advantage plans in your area that include the cataract surgery coverage you’re seeking. If you are already enrolled in a Medicare Advantage plan, you can check your Evidence of Coverage (EOC) or speak with your plan provider or a Connie Health agent to review your plan.
Original Medicare covers part of the cost of cataract surgery for traditional intraocular lenses. Medicare Part B covers the cost of the surgery in an outpatient setting, surgical center, or doctor’s office. Original Medicare will cover mono-focal lenses.
The national average for cataract surgery is $3,500 per eye. Medicare Part B will cover 80% of the Medicare-approved amount for cataract surgery. You would pay the Medicare Part B deductible, 20% of the Medicare-approved amount, plus any medications.
If you want multifocal or toric lenses, laser, or New Technology Intraocular Lenses (NTIOLS), you may be required to cover more than 20% or even the full cost. Laser-assisted cataract surgery or advanced lens implants can cost between $4,000 and $6,000 per eye. You should check with your ophthalmologist and doctor to discover their recommended procedure.
If you’d like cataract surgery not covered by Original Medicare, you may want to consider two Medicare plans: Medicare Supplement and Medicare Advantage.
A Medicare Supplement (Medigap) plan can help you pay for some or all of the coinsurance costs not covered by Original Medicare. A Medicare Advantage plan provides equal benefits to Original Medicare, oftentimes with increased coverage and benefits like vision, dental, and hearing. Medicare Advantage coverage could help you afford your vision exams that are not covered by Original Medicare and make cataract surgery that is not covered by Original Medicare more affordable.
If you want to explore a Medicare Advantage plan with comprehensive vision coverage, including cataract surgery, in your area, speak with a local licensed Connie Health agent. If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC), or speak with your plan provider or a Connie Health agent to review your plan’s coverage.
Original Medicare might cover laser cataract surgery. It must be medically necessary for it to be covered.
Medicare Part B pays 80% of the cost of traditional cataract surgery and may pay the same for medically necessary laser cataract surgery. You must pay the Medicare Part B deductible, minimum 20% coinsurance, and the cost of medications. Advanced treatments, like laser, multifocal, or toric lenses, may require a higher coinsurance, or you may need to cover the entire cost.
Alternatively, Medicare Advantage plans may provide laser cataract surgery at a better cost and coverage. These plans provide equal coverage to Original Medicare but often with better coverage and extra benefits like comprehensive vision, dental, and hearing. If you’d like to explore Medicare Advantage plans that cover laser cataract surgery, a local licensed Connie Health agent can help.
If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC) or speak with your plan provider or a Connie Health agent to review your plan’s coverage.
Yes, Original Medicare Part B helps pay for corrective lenses if you have cataract surgery that implants an intraocular lens. You can get one pair of eyeglasses with standard frames OR one set of contact lenses, but not both.
After you meet the Medicare Part B deductible, you pay 20% of the Medicare-approved amount for corrective lenses. If you want an upgraded frame, you will pay all additional costs. Also, Medicare will only pay for contact lenses or glasses from a Medicare-enrolled supplier, no matter if you or your supplier submits a claim. So, check whether your corrective lens supplier is Medicare enrolled, or you could pay entirely out-of-pocket.
Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage plus cataract surgery without out-of-pocket coinsurance costs. If you want to explore Medicare Advantage plans that include eye exams, glasses, contacts, and other routine vision, a local licensed Connie Health agent can help.
And if you’re already enrolled in a Medicare Advantage plan you can review your Evidence of Coverage (EOC), or speak with your plan provider or a Connie Health agent to review your plan’s vision coverage.
The average cost of cataract surgery is $3,500 per eye for a traditional intraocular lens procedure. If you want a more advanced procedure or lens, such as laser-assisted or advanced lens implants, cataract surgery could cost $4,000 to $6,000 per eye. Keep in mind that Original Medicare coverage varies for these procedures.
Original Medicare Part B will cover 80% of the Medicare-approved amount for a traditional intraocular lens procedure. You would pay the Medicare Part B deductible, 20% coinsurance, plus medication costs.
Original Medicare may cover multifocal or toric lenses, laser, or New Technology Intraocular Lenses (NTIOLS), but at a higher cost sharing. The requirement is that the procedure must be medically necessary.
Alternatively, a Medicare Advantage plan often provides cataract surgery without out-of-pocket coinsurance costs. Medicare Advantage plans provide equal coverage to Original Medicare and often offer better cost-sharing or benefits. These plans may offer lower costs for multifocal or toric lenses, laser, or NTIOLS. Most Medicare Advantage plans offer comprehensive vision, including vision exams, eyeglasses, and contacts.
If you want to explore Medicare Advantage plan options that include cataract surgery and the benefits you want, a local licensed Connie Health agent can help. Or, if you’re already enrolled in a Medicare Advantage plan, you can check your Evidence of Coverage (EOC) or contact your plan provider or a Connie Health agent to review your coverage of cataract surgery.
No. Original Medicare (Medicare Part A and Medicare Part B) does not cover routine eye exams to determine whether you have cataracts.
A Medicare Advantage plan is the only Medicare plan that may provide eye exam coverage. These plans provide equal coverage to Original Medicare, often with better benefits, cost-sharing, and extra benefits, including comprehensive vision, dental, and hearing. With a Medicare Advantage plan, you may be able to have your eye exams, glasses, contact lenses, and additional routine vision services covered.
If you’d like to review Medicare Advantage plans that include routine vision, including eye exams for cataracts and cataract surgery, a local licensed Connie Health agent can help. If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC) or speak with your plan provider or a Connie Health agent to determine if your plan covers eye exams for cataracts and cataract surgery.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.
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