Does Medicare Cover Cataract Surgery? You May Be Surprised

By: Edward Neeman
Published: Wednesday, October 03 2018
Last Updated: 4 years ago

As cataracts are not a life-threatening condition, but rather a loss of visual acuity, many would assume that the surgery is not covered. However, these procedures are covered under virtually all Medicare plans. Although, there is a question of the extent and nature of that coverage.

Will Medicare Pay For Your Cataract Surgery?

You may be wondering if Medicare will cover your cataract surgery, and you may be pleasantly surprised by the answer. Under Original Medicare, this surgery is considered as an outpatient service and is thus covered under Medicare Part B. Other Medicare plans offer the same services, but the rates and conditions will vary slightly.

If you have a Medicare Advantage plan, you have very little to worry about. All the relevant costs should be covered. If you have basic Medicare, you will be covered for all basic services associated with your condition.

Guidelines For Medicare Cataract Surgery

Normally, vision services are not covered under Medicare. Cataract surgery is an exception to this rule because it is considered to be medically necessary. The standard plan will cover the surgery itself, basic lens implants, and one pair of contact lenses or glasses after the surgery. Medicare cataract surgery falls into one of two categories.

Types Of Cataract Surgery

A cataract is basically just an occlusion of your eye's natural lens. There are multiple methods of removing these occlusions and restoring visual acuity. However, the two most common methods are phacoemulsification and laser surgery. There are certain risks associated with these procedures, including loss of vision. As such, it is very important to consult closely with a qualified doctor to determine which option is the best for you.

Phacoemulsification (Phaco) Cataract Surgery

Phaco cataract surgery uses sound waves to break up an occlusion so that it can be removed, thus restoring visual acuity. The procedure begins with a small retinal incision followed by the insertion of fluids for support. The top of the lens capsule is removed to expose the lens and remove the cataract.

The removal process is usually accomplished through the use of ultrasonic waves. These are used to emulsify the cataract so that it can be safely removed via suction. An implant is then placed into the empty lens capsule. This method is cheaper but tends to be less precise.

Laser Cataract Surgery

Laser cataract surgery uses a laser to remove occlusions on the optical lens. Laser cataract surgery is considered less invasive than the phaco method. The procedure begins with a detailed eye scan which maps out the structures of your eye. This is used to program a machine. The procedure for a laser cataract surgery is similar to the process of phacoemulsification but is far more exact. This is because a laser can be far more accurate than any human hand.

Another significant difference is that laser surgery does not make use of ultrasonic waves. The laser is used to soften the cataract, making for a less dangerous and traumatic procedure.

How Much Do Cataract Procedures Cost?

This is an impossible question to answer with accuracy because it will vary according to your healthcare provider, and your healthcare plan. Income affects Medicare in a significant way. There are special rules for both higher and lower-income beneficiaries.

If you make more than $170,000 a year, your premiums will be higher. This applies to those who file taxes as a married couple. If you file any other way, the upper limit is $85,000 per year. To qualify for the low-income program, your income must be no more than $1,226 per month as an individual, or $1,644 for a couple.

How Much Does Medicare Cover?

Again, this will vary according to your plan. Contact your plan provider for exact details. Under most circumstances, they will cover all the costs of the surgery itself. Certain peripheral expenses may be your own responsibility. Depending upon your plan and your provider, you may incur some debt from the procedure. It is important to know your rights, know the system, and know your individual plan.

One limitation is that Medicare will only pay for a basic type of implant. If your doctor recommends a more complex type of eye implant, you could incur some costs as a result.

Contact lenses and glasses are another set of issues to consider. As stated before, the first pair will normally be covered after your Medicare cataract surgery. This does not mean that they will be completely free. You will pay 20% of the costs on a covered pair of glasses or contact lenses. After this, however, you are on your own. If your plan is rejected, there is an appeal process.