Is cataract surgery covered by Medicare Advantage?

Does Medicare advantage cover cataract surgery? Whether you're looking for surgery, glasses, or a combination of treatments, know what Medicare will cover for you.

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Chris Tepedino is a feature writer that has written extensively about home, life, and car insurance for numerous websites. He has a college degree in communication from the University of Tennessee and has experience reporting, researching investigative pieces, and crafting detailed, data-driven features. His works have been featured on CB Blog Nation, Flow Words, Healing Law, WIBW Kansas, and C...

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Laura Walker graduated college with a BS in Criminal Justice with a minor in Political Science. She married her husband and began working in the family insurance business in 2005. She became a licensed agent and wrote P&C business focusing on personal lines insurance for 10 years. Laura serviced existing business and wrote new business. She now uses her insurance background to help educate...

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Reviewed by Laura Walker
Former Licensed Agent

UPDATED: Nov 30, 2021

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The Rundown

  • Medicare Advantage is required to cover everything that Original Medicare does, so it will cover at least the removal of a cataract, the implantation of a new lens, and one pair of eyeglasses or contact lenses after the surgery
  • Cataract surgery may cost between $195 and $383 out of pocket as your 20% coinsurance, but you will also need to pay your deductible
  • Original Medicare does not cover routine eye exams or eyeglasses, but Medicare Advantage plans may provide extra vision benefits

If you have been diagnosed with a cataract or you are concerned about them developing in the future, you may be confused.

Many people want to know the simple answer to, “does Medicare advantage cover cataract surgery?” To get real answers, you need to understand how your Medicare health insurance covers the vision services you need.

Fortunately, Medicare provides coverage for cataract surgery and the treatments that go along with it. Read more below to get answers to your questions, such as “Does Medicare Advantage cover cataract surgery?” and, “Is cataract surgery covered by Medicare?”

Enter your ZIP code into our free quote comparison tool above to find affordable health insurance rates from a health insurance company near you.

Does Medicare Advantage cover cataract surgery?

Does Medicare cover cataract surgery? Original Medicare will cover the removal of a cataract and lens implantation. Depending on how the procedure is done, different parts of Medicare will cover the surgery.

Medicare Part A covers inpatient expenses. While cataract surgery doesn’t typically require an inpatient stay, it’s good to know the coverage is there just in case.

Medicare Part B covers outpatient procedures. So this would be the primary coverage for a Medicare cataract surgery.

Medicare Part D is responsible for covering prescription drugs. If you need a prescription drug after your cataract surgery, and it is on the approved list, then Part D will cover it. Some medications may also be covered by Medicare Part B.

If you have a Medicare Advantage plan, your coverage limits may differ. However, all Medicare Advantage plans must cover at least what Original Medicare covers. Therefore, your MA plan should cover a cataract surgery, and you may even receive additional benefits.

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What is a cataract and cataract surgery?

A cataract occurs when the clear lens of your eye becomes cloudy or stiff. Some symptoms of a cataract may include cloudy or blurred vision, faded colors, double vision, difficult seeing in the dark, sensitivity to bright lights, and changes in vision.

Cataract surgery is a procedure that removes the cloudy or stiff lens and replaces it with a new one. An eye surgeon typically performs this surgery as an outpatient procedure.

How much does cataract surgery cost?

Does Medicare pay for cataract surgery? There are a few different factors that affect how much a cataract surgery costs. If you get your cataract surgery done in a surgery center or clinic, the total cost may be around $977. Medicare would pay $781, and you would have to pay $195.

If you get your cataract surgery done in a hospital, the total cost may be around $1,917. Medicare would pay $1,533, and you would have to pay $383.

The cost of your cataract surgery may vary based on how complicated your surgery is, the location of the surgery, the anesthesia or other medications involved, and more.

Does Medicare cover glasses or other vision services?

Does Medicare pay for glasses? Medicare coverage for cataract surgery includes one pair of eyeglasses or contact lenses after the procedure. However, you may end up paying 20% out of pocket, and they must be provided by a Medicare-approved doctor.

Medicare will also cover an initial exam and follow-up care after a cataract surgery.

Does Medicare cover eyeglasses not associated with a cataract surgery? Original Medicare does not provide coverage for routine eye exams or eyeglasses. Medicare Advantage plans may provide some vision benefits, but you will need to contact your plan provider to find out.

In some special cases, Medicare Part B may cover eye exams if needed for preventative and diagnostic reasons. This includes people who are high risk for glaucoma, or people with diabetic retinopathy or age-related macular degeneration.

If you are looking to buy health insurance for cataract surgery, enter your ZIP code into our free quote comparison tool below to compare health insurance quotes from companies in your area.

  1. https://www.mayoclinic.org/diseases-conditions/cataracts/symptoms-causes/syc-20353790

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