Does Medicare Cover Cataract Surgery?
Key Points
- Medicare Part B covers cataract surgery when deemed medically necessary.
- Medicare also covers one pair of eyeglasses or contact lenses after surgery.
- Standard intraocular lenses are covered; upgraded lenses may cost extra.
Cataracts are one of the most common conditions affecting Medicare beneficiaries. The good news is that Medicare does cover cataract surgery — here's what you need to know.
Does Medicare Pay for Cataract Surgery?
Yes. Medicare Part B covers cataract surgery when your doctor determines it is medically necessary — meaning the cataract is significantly impairing your vision and affecting your daily life. Medicare will pay 80% of the Medicare-approved cost after you've met your Part B deductible. If you have a Medigap plan like Plan G, it covers the remaining 20%, leaving you with little to no out-of-pocket cost.
The surgery is typically performed as an outpatient procedure, so Part B applies rather than Part A (which covers inpatient hospital stays).
Are Eyeglasses Covered After Surgery?
Ordinarily, Medicare does not cover routine eyeglasses or contact lenses. However, there is a one-time exception: after cataract surgery that involves implanting an intraocular lens, Medicare will cover one pair of eyeglasses or one set of contact lenses from any provider that accepts Medicare. The same 80/20 cost-sharing applies.
This benefit applies once per eye — so if you have cataracts in both eyes and have surgery on each, you're entitled to glasses following each procedure.
What About Upgraded Lenses?
During cataract surgery, a standard intraocular lens (IOL) is implanted to replace the clouded natural lens. Medicare covers the cost of a standard monofocal IOL. However, if you opt for a premium lens — such as a multifocal or toric lens that corrects astigmatism or reduces dependence on reading glasses — you will be responsible for the additional upgrade cost, as Medicare considers those enhancements elective.
Talk to your eye surgeon about the lens options available to you and what the out-of-pocket cost difference would be for any upgrades.
What If I Have Medicare Advantage?
If you're enrolled in a Medicare Advantage plan (Part C), cataract surgery is still covered because all Medicare Advantage plans must cover at minimum what Original Medicare covers. However, your cost-sharing, copays, and network restrictions will be determined by your specific plan. Always verify with your plan before scheduling surgery.
Still Have Questions?
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