Medicare covers most of the cost of cataract removal, but you will pay a portion depending on whether you have Original Medicare or a Medicare Advantage plan.

Under Original Medicare (Part A and Part B), cataract surgery is covered as an outpatient procedure. Medicare pays 80% of the approved amount after you meet your Part B deductible for the year. You pay the remaining 20%, which is called coinsurance. The exact dollar amount you owe depends on what your surgeon's office charges and whether they accept Medicare's approved amount as payment in full.

If you have a Medicare Advantage plan (Part C), your out-of-pocket cost works differently. Each plan sets its own copay or coinsurance for cataract surgery. Some plans charge a flat copay (for example, $250), while others charge a percentage of the cost. You should call your plan before scheduling surgery to find out your exact responsibility.

Cataract surgery includes the removal of the clouded lens and placement of an intraocular lens (IOL) implant. Medicare covers a standard IOL. If you choose a premium IOL — one designed to correct astigmatism or provide multifocal vision — Medicare does not cover the difference in cost, and you will pay that extra amount out of pocket.

Key Takeaways

  • With Original Medicare, you pay 20% coinsurance after meeting your Part B deductible; the exact dollar amount depends on your surgeon's charges and whether they accept Medicare's approved amount.
  • Medicare Advantage plans each set their own copay or coinsurance for cataract surgery, so you must contact your specific plan to learn what you will owe.
  • Medicare covers a standard intraocular lens implant but not the additional cost of premium lens options like multifocal or astigmatism-correcting lenses.
  • Both Original Medicare and Medicare Advantage cover pre-surgery testing, the surgery itself, and post-surgery follow-up visits related to the procedure.
  • You should ask your surgeon's office whether they are in-network with your plan and whether they accept Medicare assignment before scheduling.

How to Find Out Your Exact Cost Before Surgery

Your surgeon's office can tell you the charge for the procedure, but you need to contact Medicare or your plan separately to learn what you will owe. If you have Original Medicare, call 1-800-MEDICARE and give them your procedure code (the code for cataract surgery is 66984 for most cases). They can tell you the approved amount in your area, which lets you calculate your 20% coinsurance.

If you have a Medicare Advantage plan, call the customer service number on your insurance card. Ask specifically: "What is my copay or coinsurance for cataract surgery performed as an outpatient procedure?" and "Is my surgeon in-network?" Some plans require pre-authorization before surgery, meaning your surgeon's office must contact the plan and receive approval before the procedure is scheduled.

Ask your surgeon's office to provide an estimate in writing. They should tell you the total charge, the amount Medicare will pay, and what you will owe. This estimate helps you plan financially and gives you a chance to catch any errors before surgery day.

What Happens If Your Surgeon Does Not Accept Medicare Assignment

Most surgeons who perform cataract surgery accept Medicare assignment, meaning they agree to accept Medicare's approved amount as full payment (except for your coinsurance). If your surgeon does not accept assignment, they can charge you more than Medicare's approved amount, and you will owe the difference on top of your coinsurance.

For example, if Medicare's approved amount is $3,000 and your surgeon charges $4,000 without accepting assignment, you would owe 20% of $3,000 (your coinsurance) plus the full $1,000 difference — a total of $1,600. This is called balance billing. Before scheduling surgery, ask your surgeon's office: "Do you accept Medicare assignment for cataract surgery?" If they say no, you can choose a different surgeon or decide whether the extra cost is acceptable to you.

Original Medicare Versus Medicare Advantage: Cost Differences

With Original Medicare, your cost is predictable once you know the approved amount and whether you have met your deductible. You pay 20% coinsurance, and that is your only responsibility (unless your surgeon does not accept assignment). There is no annual out-of-pocket maximum, so if you have multiple procedures in one year, your costs can add up.

Medicare Advantage plans often have lower copays for individual procedures, but they include an annual out-of-pocket maximum. Once you reach that maximum, the plan pays 100% of covered services for the rest of the year. Some plans also cover vision exams or eyeglasses, which Original Medicare does not. However, Medicare Advantage plans may require you to use in-network providers, and some require pre-authorization.

Neither Original Medicare nor Medicare Advantage covers routine eye exams or glasses unless they are medically necessary after cataract surgery. If your cataract surgery corrects your vision enough that you no longer need glasses, Medicare will not pay for new glasses afterward.

Pre-Surgery Testing and Follow-Up Visits

Before cataract surgery, you will have testing to measure your eye and determine the correct power of your IOL implant. This testing is covered by Medicare. You will also have a pre-surgery medical evaluation to make sure you are healthy enough for the procedure; this is covered as well.

After surgery, you will have follow-up visits at one day, one week, and four weeks post-surgery, and sometimes longer. These visits are covered by Medicare as part of the surgical package. You pay your normal coinsurance (20% with Original Medicare) or your plan's copay (with Medicare Advantage) for each visit, just as you would for any other office visit.

If you develop complications after surgery — such as infection, inflammation, or problems with the IOL — treatment for those complications is covered. However, if you choose a premium IOL and later have problems related to that lens, you may have additional out-of-pocket costs depending on what treatment is needed.

When Medicare May Not Cover Cataract Surgery

Medicare covers cataract surgery when the cataract is affecting your vision enough to interfere with your daily activities. Your eye doctor must document that your vision loss is caused by the cataract and that surgery will improve your sight. If you have a cataract but your vision is still good, Medicare may not cover surgery until your vision declines.

If you are having cataract surgery in both eyes, Medicare covers both procedures, but they are usually scheduled weeks apart. You will pay coinsurance for each surgery separately. If your second eye surgery is in a different calendar year, you may need to meet your Part B deductible again.

Medicare does not cover cataract surgery if it is performed at the same time as another elective procedure (such as LASIK or refractive surgery to correct your prescription). If your surgeon performs both procedures together, Medicare will only pay for the cataract removal, and you will pay out of pocket for the refractive procedure.

Frequently Asked Questions

Do I have to pay my Part B deductible before Medicare pays for cataract surgery?

Yes. You must meet your Part B deductible each calendar year before Medicare begins paying its share. Once you meet the deductible, Medicare pays 80% and you pay 20% coinsurance. If your cataract surgery is early in the year and you have not yet met your deductible, you will pay the full deductible amount plus 20% coinsurance.

What if I choose a premium lens implant?

Medicare covers the cost of a standard monofocal IOL implant. If you choose a premium lens — such as a multifocal lens (for reading and distance vision) or a toric lens (for astigmatism) — you pay the difference between the standard lens cost and the premium lens cost. This difference is typically $500 to $2,000 per eye, depending on the lens type and your surgeon's fees.

Will my Medicare Advantage plan cover cataract surgery if I use an out-of-network surgeon?

Most Medicare Advantage plans will cover out-of-network cataract surgery, but you will pay more — usually a higher copay or coinsurance than you would in-network. Some plans require pre-authorization even for out-of-network providers. Call your plan before scheduling to learn your exact cost and whether pre-authorization is needed.

Can I have cataract surgery at an ambulatory surgery center instead of a hospital outpatient department?

Yes. Medicare covers cataract surgery at ambulatory surgery centers, hospital outpatient departments, and office-based surgery centers. Your cost is the same regardless of location. Ask your surgeon where the procedure will be performed and whether that facility is in-network with your Medicare Advantage plan.

What if I cannot afford my coinsurance?

If you have limited income, you may be may be able to access for Medicare Savings Programs, which are run by your state and can help pay your deductible and coinsurance. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to. Some charitable organizations also help seniors pay for cataract surgery; your eye doctor's office may know of local resources.