Does Medicare Cover Cataract Surgery?

How is cataract surgery covered by Medicare?

The short answer is yes, Medicare covers cataract surgery.

Part B covers cataract surgery and its associated costs, such as anesthesia, operating room facilities, and supplies. However, there are certain conditions that must be met for Medicare to cover cataract surgery.

Firstly, you must have a doctor’s referral that confirms you need cataract surgery to improve your vision. Medicare covers cataract surgery if the surgery is necessary to improve your vision to the level required for driving, reading, or other activities of daily living.

Secondly, you must ensure that your cataract surgeon accepts Medicare. Not all doctors accept Medicare, so it is essential to confirm this before undergoing the surgery. If your doctor accepts Medicare, they will file a claim on your behalf, and Medicare will pay for the covered expenses.

Thirdly, you must pay the Part B deductible. As of 2023, the Part B deductible is $226 per year. Once you have paid the deductible, Medicare will cover 80% of the Medicare-approved cost of the cataract surgery. You will be responsible for paying the remaining 20%.

Cataract Surgery is not part of Vision Insurance

Cataract surgery can sometimes be misconstrued as being covered under “vision” insurance, but it’s actually covered under Medicare Part B as an outpatient procedure.

While vision insurance may cover routine eye exams and corrective lenses, it typically does not cover surgeries such as cataract removal. Medicare Part B, on the other hand, covers medically necessary procedures, including cataract surgery.

However, even though cataract surgery is covered under Medicare Part B, there may still be out-of-pocket costs, such as deductibles and coinsurance. This is where Medicare Supplement Insurance plans can be helpful in covering those costs.

It’s important to understand the specifics of your insurance coverage and speak with your healthcare provider to ensure you have a clear understanding of the costs associated with cataract surgery.

How does Medigap cover cataract surgery?

Medigap plans, also known as Medicare Supplement Insurance plans, can help cover the costs associated with cataract surgery. Original Medicare (Part A and Part B) covers some aspects of cataract surgery, such as the surgical procedure itself and a portion of the associated costs.

However, there may be out-of-pocket expenses left over, such as deductibles, copays, and coinsurance. Medigap plans can help cover these costs, depending on the specific plan you have. Medigap plans typically supplement the ‘gaps’ that are not covered by Parts A and B.

It’s important to note that Medigap plans are sold by private insurance companies, so the specific coverage and costs may vary depending on the plan you choose.

How do Medicare Advantage Plans (Part C) cover cataract surgery?

If you have a Medicare Advantage plan, also known as Part C, you may have additional benefits and lower out-of-pocket costs for cataract surgery.

Medicare Advantage plans are offered by private insurance companies approved by Medicare and provide the same coverage as Parts A and B. Cataract surgery is generally covered under Outpatient Hospital services for Part C plans.

In summary, Medicare covers cataract surgery if it is medically necessary to improve your vision. To be eligible for coverage, you must have a doctor’s referral, ensure that your cataract surgeon accepts Medicare, and pay the Part B deductible. A beneficiary would also need to confirm that the surgeon is in the Medicare Advantage plan’s network. If you have a Medicare Advantage plan, you may have additional benefits and lower out-of-pocket costs.

It is essential to talk to your doctor and insurance provider to understand the costs and coverage details before undergoing cataract surgery.