Medicare Part B covers cataract removal surgery, including laser-assisted procedures, when a doctor determines the cataract is affecting your vision enough to need treatment

Medicare Part B pays 80 percent of the approved amount for cataract surgery once you have met your annual deductible. You pay the remaining 20 percent, plus any difference between what Medicare approves and what your surgeon charges (called balance billing) if your surgeon does not accept Medicare rates. The type of laser used — femtosecond laser or traditional phacoemulsification — does not change whether Medicare covers the procedure, but it may change what you pay out of pocket.

The key requirement is that your eye doctor must document that the cataract is reducing your vision enough to interfere with daily activities. Medicare does not cover cataract surgery for cataracts that are present but not yet affecting sight, or for surgery done purely for cosmetic reasons.

Key Takeaways

  • Medicare Part B covers the surgeon's fee for cataract removal, including laser-assisted surgery, after you meet your annual deductible.
  • You pay 20 percent of the Medicare-approved amount, plus any balance-billing charges if your surgeon does not accept Medicare rates.
  • Your doctor must document that the cataract is reducing your vision enough to affect daily life before Medicare will cover the surgery.
  • Facility fees (the cost of the surgery center or hospital) are covered separately under Part B, and you pay 20 percent of that approved amount as well.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20 percent.

What Medicare Part B actually pays for

Medicare Part B covers the surgeon's professional fee and the facility fee (the cost of using the operating room or surgery center). It also covers the intraocular lens — the artificial lens implanted during surgery to replace the clouded natural lens. The laser equipment itself is part of the facility fee, so you do not pay separately for the laser technology.

The surgery must take place at a Medicare-approved facility. Most hospitals and ambulatory surgery centers are approved. Your surgeon's office can confirm whether their facility accepts Medicare before you schedule.

What you pay out of pocket

Your costs depend on whether you have met your Part B deductible for the year. For 2024, the Part B deductible is $240. Once you meet it, you pay 20 percent of the Medicare-approved amount for both the surgeon's fee and the facility fee.

If your surgeon charges more than Medicare approends, you are responsible for the difference — unless your surgeon has signed an agreement to accept Medicare rates. Ask your surgeon's office whether they accept assignment (meaning they accept Medicare's approved amount as full payment). Surgeons who do not accept assignment can bill you for the difference, which can add hundreds of dollars to your bill.

If you have a Medigap policy, it typically covers the 20 percent coinsurance, reducing your out-of-pocket cost to zero or close to it. If you have a Medicare Advantage plan, your costs depend on your plan's copay or coinsurance structure — some plans charge a flat copay for surgery, others charge coinsurance. Check your plan documents or call the plan to find out what cataract surgery costs under your specific coverage.

How to confirm Medicare will cover your surgery

Your eye doctor (ophthalmologist or optometrist) must perform a vision test and document that your cataract is reducing your sight. Medicare uses specific measurements: your visual acuity must be 20/40 or worse in the affected eye, or your vision must be reduced enough that it is affecting your ability to perform daily tasks. Your doctor will note this in your medical record.

Once your doctor determines you need surgery, ask the surgeon's office to submit a pre-authorization request to Medicare. Medicare will review the documentation and send you a notice saying whether the surgery is covered. This usually takes a few days. You will receive a document called an Advance Beneficiary Notice (ABN) if Medicare is likely to deny coverage — this gives you the chance to decide whether to proceed and pay out of pocket.

If you are unsure whether your specific situation is covered, you can call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and ask. Have your Medicare number and your doctor's name ready.

Laser-assisted surgery versus traditional phacoemulsification

Femtosecond laser-assisted cataract surgery uses a laser to make the incision and soften the cataract before removal. Traditional phacoemulsification uses ultrasound waves to break up the cataract. Both are covered by Medicare at the same rate — Medicare does not pay more for laser-assisted surgery, and it does not pay less.

Some surgeons charge patients extra out of pocket for laser-assisted surgery, calling it a "premium" procedure. If your surgeon does this, the extra charge is your responsibility, not Medicare's. Ask your surgeon in advance whether there is an additional out-of-pocket cost for laser-assisted surgery beyond what Medicare covers.

What happens if Medicare denies coverage

Medicare may deny coverage if your vision loss is not yet severe enough by their measurements, or if your doctor's documentation does not clearly show that the cataract is the cause of your vision problem. If you receive a denial, you have the right to appeal. Your surgeon's office can help you gather additional documentation from your eye doctor to support an appeal.

If you disagree with the denial and want to proceed with surgery anyway, you can pay out of pocket. The surgeon should give you a written estimate of the total cost before you schedule. Some surgeons offer payment plans for patients paying without insurance.

Cataract surgery at a hospital versus an ambulatory surgery center

Medicare covers cataract surgery at both hospitals and ambulatory surgery centers (ASCs). The facility fee is usually lower at an ASC, which means your 20 percent coinsurance is lower. A hospital facility fee might be $2,000 to $3,000, while an ASC might charge $800 to $1,200 for the same procedure — these are examples only and vary by location and facility.

Ask your surgeon where they perform cataract surgery and whether both options are available to you. If you have a choice, comparing the facility fees can reduce your out-of-pocket cost. Your surgeon's office can tell you what Medicare approves for each facility.

Frequently Asked Questions

Does Medicare cover both eyes in the same surgery visit?

No. Medicare covers cataract surgery on one eye at a time. You typically wait one to two weeks between surgeries to allow the first eye to heal. Each surgery is billed separately, and you pay the 20 percent coinsurance for each eye.

What if I have a cataract in only one eye?

Medicare covers surgery on the eye with the cataract. You do not need to have cataracts in both eyes to have surgery on one. Your doctor will document that the cataract in that eye is affecting your vision.

Does Medicare cover the cost of eyeglasses after cataract surgery?

Medicare Part B covers one pair of eyeglasses or contact lenses after cataract surgery, but only if an intraocular lens was implanted. This is covered as a separate benefit with its own rules. You typically receive this benefit four to six weeks after surgery, once your eye has fully healed and your vision has stabilized.

Will I owe anything if I use a Medicare Advantage plan?

It depends on your specific plan. Some Medicare Advantage plans cover cataract surgery with no copay or coinsurance. Others charge a copay (usually $0 to $500) or coinsurance (usually 10 to 20 percent). Check your plan documents or call the plan's member services line to find out your exact cost.

Can I choose my surgeon if I want laser-assisted surgery?

Yes. You can choose any surgeon who accepts Medicare. If you want laser-assisted surgery specifically, ask your eye doctor for a referral to a surgeon who offers it. Keep in mind that any extra charge for laser technology beyond what Medicare covers is your responsibility.