Does Medicare Cover Cataract Surgery?
This article was updated on: 09/01/2017
Cataracts are strongly linked to aging, and many people develop them in one or both eyes as they get older. In fact, according to the National Eye Institute, half of all Americans will either develop a cataract or have had cataract surgery by age 80.
If you have Medicare coverage and your doctor determines that cataract surgery is medically necessary, Medicare covers the procedure to remove the cataract, as well as doctor services and related care following your surgery. You may be responsible for certain costs, including deductibles, copayments, and/or coinsurance.
Read on to learn more about cataracts and Medicare coverage of cataract surgery.
What are cataracts, and how do they affect vision?
According to the National Eye Institute, a cataract occurs when the lens of your eye becomes cloudy. The lens is the clear part at the front of the eye that helps you to focus on an image. When functioning normally, light enters your eye through the lens and passes to the retina, which then sends signals to your brain that help you process what you see as a clear image. When the lens is clouded by a cataract, light doesn’t pass through your eye to your retina as well, and your brain can’t process images clearly, resulting in blurry vision.
Cataracts can occur in one or both eyes, but they cannot spread from one eye to the other. Your chances of developing cataracts increase significantly with age.
Some people develop cataracts at a much younger age, such as in their 40s or 50s. However, these cataracts tend to be smaller in size and do not usually affect vision. In general, people don’t experience vision problems from cataracts until they reach their 60s.
What causes cataracts?
These lens of your eye is made up of water and proteins, and under normal circumstances, the proteins are arranged in such a way that light passes through the lens uninhibited. However, as you age, these proteins can clump together and block the lens, forming a cataract that clouds your vision. Researchers aren’t sure why this happens, although they theorize that your body’s natural wear and tear as it ages may alter the composition of your proteins and how they behave.
While age remains the biggest risk factor for cataracts, other factors may also make it more likely for them to form:
- Certain diseases, such as diabetes
- Alcohol use
- Prolonged exposure to sunlight
You can also develop a cataract after eye surgery to treat another condition (for example, glaucoma) or if you’ve suffered an eye injury. If you’ve been exposed to radiation, you may also be at risk for developing radiation cataracts.
What are the symptoms of cataracts?
Only a doctor can diagnose cataracts, but if you experience any of the following symptoms, it’s a good idea to see your doctor:
- Blurred or cloudy vision
- A glare or halo affect when you look at a lamp or light
- Colors that appear faded
- Trouble seeing at night
- Double vision
These symptoms can also occur with other conditions, so be sure to have your eyes checked by your doctor if you are concerned.
How do I know if I need cataract surgery?
In the early stages, a cataract may be treated with:
- Eyeglasses or magnifying lenses
- Environmental adjustments (for example, brighter lighting)
- Anti-glare sunglasses
If the above solutions aren’t helping and your vision is impairing your everyday life, you may need cataract surgery.
During cataract surgery, your doctor will remove the cataract from your lens and replace the cloudy lens with an artificial lens. The operation lasts about an hour; your doctor may recommend that you remain awake for the procedure, although in some cases, you may have general anesthesia. Most people go home from surgery the same day, although you’ll need to arrange to have someone take you home. You may need new prescription glasses or contact lenses once your eye heals.
What are risks of cataract surgery?
As with any surgery, there are certain risks, including loss of vision, double vision, infection, or inflammation. However, according to the National Eye Institute, cataract surgery remains one of the safest and most common ways to treat cataracts, and 90% of those who get the surgical procedure have improved vision after.
Talk to your doctor about the risks of cataract surgery and whether this might be the right course of treatment for you.
How does Medicare cover cataract surgery?
Medicare covers cataract surgery to implant an intraocular lens, including hospital and doctor services during and after your operation and corrective lenses after your surgery. If you have the procedure as an outpatient, Medicare Part B will cover your treatment, and you may be responsible for any applicable deductibles, copays and/or coinsurance costs. If you are admitted to the hospital for surgery, you’ll be covered under Medicare Part A, and your coverage and costs will be different. Since your costs will vary depending on the specific services you receive and whether you’re covered under Part A or Part B, it’s important to talk to your doctor beforehand to get a better estimate of how much your cataract surgery may cost.
After your surgery, Medicare Part B covers corrective lenses after you’ve had a cataract surgery to implant an intraocular lens. In this instance, Medicare may pay for one pair of glasses or contact lenses if you get them through a Medicare-enrolled supplier. You may owe a 20% coinsurance for the glasses or contact lenses, and the Part B deductible applies. Keep in mind that Medicare doesn’t otherwise cover most routine vision services, and you’ll be responsible for paying for the cost for upgraded frames or additional vision care unrelated to your cataract surgery.
What are other Medicare coverage options for cataract surgery?
You have other options to help manage your cataract surgery costs. A Medicare Supplement plan may cover all or part of certain out-of-pocket costs, such as your deductibles, copayments, and coinsurance amounts. Many people choose a Medicare Supplement plan, or Medigap plan, to help manage their health-care costs in Original Medicare. Some plans also cover Part B excess charges that may apply; these charges are the difference between the amount Original Medicare covers for a given service and what your doctor charges. You’re usually responsible for paying this difference if your doctor charges above the Medicare-approved amount, but some Medicare Supplement plans include benefits that cover these costs.
As an alternative way to get your Original Medicare Part A and Part B coverage, you might consider Medicare Advantage(Part C). If you are covered under a Medicare Advantage plan, your out-of-pocket costs could also be lower. With a Medicare Advantage plan, you get all the same coverage you’d have under Original Medicare, but you may also have additional benefits, such as lower copayments and deductibles and even coverage for other services not covered under Part A and Part B. For example, many Medicare Advantage plans cover routine vision and dental services, which aren’t normally covered under Original Medicare. Since benefits and costs vary, check with the specific Medicare Advantage plan you’re considering. Keep in mind that Medicare Advantage plans and Medicare Supplement plans don’t work together; you can only use Medicare Supplement benefits to help pay for your costs that Original Medicare doesn’t cover.
Want more information about Medicare coverage for cataract surgery?
As you can tell, you have several choices if you need cataract surgery and are concerned about coverage. If you’d like help finding a Medicare Advantage or Medicare Supplement plan that may help with cataract surgery costs, I am happy to help you understand your options. If you’d prefer a phone call or email with personalized information, click the corresponding link below to do that. The Compare Plans button will show you information about plan options you may be eligible for. For the quickest response, call 1-844-847-2660 or 711 for TTY users, and I or one of my licensed insurance agent colleagues will be glad to answer your questions. Our licensed insurance agents are available Monday through Friday, 8AM to 8PM ET.
For other resources on cataract surgery and Medicare coverage, see:
Medicare.gov, “Cataract surgery,” https://www.medicare.gov/coverage/cataract-surgery.html
National Institutes of Health, National Eye Institute, “Facts About Cataract,” nei.nih.gov/health/cataract/cataract_facts
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