Does Medicare Cover Cataract Surgery in 2024?

If you’re new to Medicare or making different elections for the coming year, you may be wondering about specific coverage areas. For instance, can Medicare help with eye health, namely cataract surgery?

Medicare – the federal health insurance program for people ages 65 and older, as well as certain people with disabilities younger than 65 – may be able to help you get this corrective surgery and any post-surgery vision care you might need.

Cataracts are common among older adults. They develop when proteins in your eye break down and cause a clouding of the natural lens. This lens bends and refracts light rays that come into the eye, so when it gets cloudy, what you see can look hazy – like looking through a foggy window.

Symptoms of cataracts can also include:

Cataracts can lead to blindness and can impact your safety as they’re developing. The good news is that they can be corrected with surgery.
During cataract surgery, your surgeon will remove the eye’s cloudy natural lens and replace it with a clear artificial lens. Called an intraocular lens, or IOL, this plastic device works just like your natural lens did when it was clear.

“Many beneficiaries don’t realize it, but Medicare covers cataract surgery in most cases,” says Bob Rees, vice president of Medicare sales and member loyalty with eHealth, Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
Original Medicare doesn’t provide routine vision care, he adds, but it does cover the diagnosis and treatment of cataracts, including traditional or laser surgery to correct cataracts with an IOL.

Keep in mind: Medicare covers cataract surgery when it has been deemed “medically necessary,” which means the cataracts are causing significant vision impairment. When corrective lenses and assistive devices are no longer enough for you to complete daily tasks, then you’ve probably met the threshold for medical necessity. Your ophthalmologist can advise you on that diagnosis.

Cataract surgery, as mentioned, is usually conducted as an outpatient procedure. Medicare Part B covers the cost of the surgery once you’ve met your deductible. (In 2024, the annual deductible for all Medicare Part B enrollees is $240.)

“This is a basic benefit provided under original Medicare, so it’s available to everyone,” Rees explains. “You don’t need to be enrolled in a Medicare Supplement or Medicare Advantage plan to receive this benefit, though these products can help you save on out-of-pocket costs. Some Medicare Advantage (plans) also provide routine vision care.”

If you have a traditional Medicare Part B plan, you’ll be responsible for 20% of the cost of surgery, after you’ve met the deductible. If you have a Medigap plan, you may be able to get additional coverage, either full or partial, for that 20%. Plans can vary, however, so make sure to read the fine print.

Medicare only covers standard cataract surgeries that involve the implantation of an IOL.

“Other forms of cataract surgery typically aren’t covered,” Rees notes.

Medicare also doesn’t cover advanced technology lenses or surgeries that are deemed elective, such as those to correct nearsightedness or astigmatism.

After the surgery, Medicare Part B will cover the cost of one pair of corrective glasses or contacts. Typically, Medicare doesn’t cover eyeglasses or contact lenses, but for those who’ve had cataract surgery, this post-surgery treatment is an exception. However, you may have to pay some out-of-pocket costs.

“After you’ve met your Part B deductible, you may still pay 20% of the Medicare-approved amount for corrective lenses,” Rees says. “For glasses, the coverage only extends to basic frames and lenses, so you may also pay more if you get fancier ones.”

What’s more, he notes, you have to get said lenses from the right provider.

“Medicare will only pay for your post-cataract surgery glasses or contact lenses from a supplier enrolled in Medicare. It’s not enough for them to bill Medicare for you; they must be a Medicare-enrolled supplier,” Rees explains.

Because coverage for cataract surgery is a basic Medicare benefit, you don’t need separate coverage for routine vision care.

However, some Medicare Advantage plans offer additional vision services coverage.

You do not need supplemental insurance to cover cataract surgery. Medigap plans, however, can help you cover any out-of-pocket costs.

Cataract surgery can be expensive depending on where you live and how the procedure is performed. However, Medicare sets an approved amount for procedures it covers.

According to Medicare.gov’s Cost Lookup tool, cataract surgery costs $1,101, on average. That amount is simply the fee for the facility and does not include the doctor’s fee. Your specific surgery may involve additional steps, which may also add to the cost.

Of the estimated $1,101 listed above, Medicare would pay $880, leaving $220 for the patient to make up out of pocket.

The surgeon’s fee can increase this total significantly. Generally speaking, cataract surgeries run about $3,000 to $5,000 in total depending on the complexity of the case, the doctor’s fee schedule and the location where the surgery is being performed.

The key here is to remember that with an original Medicare Part B plan, you, the patient, will be responsible for 20% of the costs associated with the surgery, so make sure you understand ahead of time what your financial responsibility will be when scheduling your surgery.

Here are some common questions Medicare beneficiaries ask when considering cataract surgery:

Yes. Medicare beneficiaries must first meet their annual deductible, which will be $240 in 2024, and pay 20% of the cost of cataract surgery. Medicare Part B covers 80% of the cost of the surgery and post-surgical corrective lenses. A Medigap plan could help you cover the remaining 20% cost you are responsible for paying.

Medicare covers the use of an IOL, which is a plastic, artificial lens that replaces the natural lens that has been clouded by cataract.

Medicare only covers traditional cataract surgery procedures that involve the implantation of an IOL. More technologically advanced devices are not covered by Medicare Part B, but if you have a Medigap or Medicare Advantage plan, your options may vary. Check the details in your plan.

Medicare will cover cataract surgery for people who have astigmatism, as long as the surgery is deemed medically necessary. The surgery won’t address the astigmatism; it will simply involve removing the clouded lens and replacing it with a clear, artificial lens.

Vision health is a key component of overall health and wellness, and you don’t need to accept clouded vision as just a part of getting older. Talk with your doctor about what you can do to address cataracts, and check your Medicare plan details for more information for your specific situation.

If you need help understanding or navigating your Medicare benefits, visit Medicare.gov or reach out to the CMS call center at 1-800-Medicare.