Does Medicare Advantage cover cataract surgery?

Over half of people over the age of 80 either have cataracts or have had cataract surgery, but the price of cataract surgery can be overwhelming. Does Medicare Advantage cover cataract surgery? It will cover basic cataract surgery, lens implants, and a pair of eyeglasses or contact lenses. Read more below to learn about your coverage options and out-of-pocket expenses.

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D. Gilson is a writer and author of essays, poetry, and scholarship that explore the relationship between popular culture, literature, sexuality, and memoir. His latest book is Jesus Freak, with Will Stockton, part of Bloomsbury’s 33 1/3 Series. His other books include I Will Say This Exactly One Time and Crush. His first chapbook, Catch & Release, won the 2012 Robin Becker Prize from Seve...

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Dec 14, 2020

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The Highlights

  • Medicare Advantage will cover at least basic cataract surgery and lens implants along with a pair of eyeglasses or contact lenses.
  • The estimated total cost of cataract surgery performed in a surgical center is $1,777.
  • Your estimated out-of-pocket expenses are estimated to be between $355 and $557, but these costs could vary.

Cataracts and cataract surgery are extremely common (over half of people over 80 either have cataracts or have had cataract surgery). The thought of having to pay for cataract surgery out-of-pocket can be overwhelming.

So, does Medicare Advantage cover cataract surgery? What will your out-of-pocket expenses be after Medicare covers their share? We’ll answer these questions below.

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Does Medicare Advantage cover cataract surgery?

So, does Medicare cover cataract surgery? Which parts of Medicare cover cataract surgery?

Medicare Part B covers cataract surgery as long as the surgery is completed using either traditional methods or lasers. Since Medicare Advantage plans have to be the same or better than original Medicare, these plans will cover the cataract surgery as well.

Medicare covers what is called an intraocular lens implant, which is a small disk that is implanted after the removal of cataracts to help with focusing your vision. However, Medicare will only cover the basic implant rather than the advanced ones.

Does Medicare Advantage cover eyeglasses and contact lenses?

After your cataract surgery, Medicare will cover one pair of eyeglasses or contact lenses. If you choose eyeglasses, you will have specific frames you can choose from. If you choose to upgrade to different frames, your out-of-pocket expenses will increase.

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How much does cataract surgery cost with Medicare?

How can you know what your costs will be before cataract surgery? What other factors may affect how much you pay?

After your premiums and health care deductible, Medicaid will generally charge a 20 percent coinsurance. This means you will have to pay 20 percent of cataract surgery costs out-of-pocket.

What is the cost with Medicare?  According to Medicare.gov, an estimated total cost of cataract surgery performed in a surgical center is $1,777. Medicare would pay $1,422, while you would need to pay $355. In a hospital, the estimated total cost is $2,786. Medicare would pay $2,229, and you would pay $557.

The cost of your surgery may vary due to multiple factors, including your Medicare plan, the specifics regarding your surgical needs, the facility and healthcare provider, and potential complications (either during surgery or due to other disorders).

Conclusion

Medicare Advantage will cover a basic cataract surgery with lens implants and one pair of eyeglasses or contact lenses.

After your premiums and deductible, you will need to pay a 20 percent coinsurance. The estimated cost for this out-of-pocket expense ranges from $355 to $557, depending on your Medicare plan, your surgical needs, the facility and doctor, and any potential complications. A Medigap plan may help cover some of these expenses.

You should contact your Medicare Advantage policyholder to get details about their cataract surgery and other vision coverage options.

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