Medicare covers cataract surgery as an inpatient or outpatient procedure, but you will owe a portion of the cost
Medicare Part B covers the surgeon's fee, the facility cost, and the intraocular lens (the artificial lens implanted during surgery) as medically necessary care. You pay 20 percent of the approved amount after you meet your Part B deductible for the year. If your surgery happens at an outpatient facility or hospital, you may also owe a copay or coinsurance for the facility itself, which varies by location and facility type.
The total out-of-pocket cost depends on three things: whether you have reached your deductible, whether the surgeon and facility accept Medicare assignment, and whether you have supplemental coverage (Medigap) or a Medicare Advantage plan. A surgeon who accepts assignment agrees to accept Medicare's approved amount as full payment for their services; if they do not, you could owe more.
The surgery itself is usually done in an outpatient setting, meaning you go home the same day. Medicare covers one eye at a time, so if both eyes need surgery, you will have two separate procedures and two separate out-of-pocket costs.
Key Takeaways
- Medicare Part B covers cataract surgery and the artificial lens, but you pay 20 percent of the approved amount after meeting your annual deductible.
- The facility where surgery occurs (hospital outpatient department, ambulatory surgery center, or office-based facility) affects your total cost because each has different copay or coinsurance rules.
- If your surgeon does not accept Medicare assignment, you may owe more than 20 percent of the approved amount.
- Medigap Plan F or Plan G covers your 20 percent coinsurance, while most Medicare Advantage plans cover cataract surgery but may require prior authorization or direct you to in-network surgeons.
Your costs under Original Medicare
Under Original Medicare (Part A and Part B), you are responsible for the Part B deductible, which is $240 in 2024. Once you meet that deductible, you pay 20 percent of the approved amount for the surgeon's services and the intraocular lens.
The facility cost is separate. If surgery happens at a hospital outpatient department, you typically owe a copay (a fixed amount set by Medicare, usually between $100 and $300, depending on the facility). If it happens at an ambulatory surgery center, you pay 20 percent of the approved amount. If it happens in the surgeon's office, there is usually no separate facility charge.
The approved amount varies by region and surgeon. Medicare publishes these amounts, and you can ask your surgeon's office what the approved amount is before surgery so you know your 20 percent cost. Do not assume the surgeon's listed price is the approved amount — it is often higher, and you only owe 20 percent of what Medicare approves, not 20 percent of the surgeon's full bill.
How to check if your surgeon accepts Medicare assignment
A surgeon who accepts assignment agrees to bill Medicare directly and accept the approved amount as full payment. You then owe only your 20 percent coinsurance. A surgeon who does not accept assignment can bill you for the difference between their fee and Medicare's approved amount — up to 15 percent more than the approved amount under the Medicare limiting charge rule.
Before scheduling, ask the surgeon's office directly: "Do you accept Medicare assignment for cataract surgery?" If they say yes, ask them to confirm it in writing. If they say no or are unsure, contact Medicare at 1-800-MEDICARE or use the Medicare Physician Comparison Tool on Medicare.gov to verify.
Most cataract surgeons accept Medicare assignment because the volume of Medicare patients makes it worthwhile. But it is worth confirming, especially if you are seeing a surgeon outside your usual area.
Costs if you have Medigap or Medicare Advantage
If you have a Medigap policy (supplemental insurance), your coverage depends on which plan you hold. Medigap Plan F and Plan G both cover your Part B coinsurance, meaning they pay the 20 percent you would otherwise owe for the surgeon and lens. They do not cover the facility copay or coinsurance, but some plans cover that too — check your policy documents or call your Medigap insurer to confirm what cataract surgery coverage includes.
If you have a Medicare Advantage plan (Part C), cataract surgery is covered, but the rules vary by plan. Most Medicare Advantage plans require you to use in-network surgeons and may require prior authorization before surgery. Some plans charge a copay for the surgeon visit and surgery; others charge coinsurance. Check your plan's summary of coverage or call the plan directly to learn your exact out-of-pocket cost before you schedule.
Medicare Advantage plans often cover the intraocular lens with no extra charge, but some plans limit which lens types are covered. If you want a premium lens (multifocal or toric, which correct astigmatism), the plan may cover only a standard monofocal lens and charge you extra for the upgrade. Ask your surgeon and your plan what lens options are covered at no extra cost.
What happens if you delay surgery
Medicare covers cataract surgery only when the cataract is affecting your vision enough to interfere with daily life. If you postpone surgery, your costs do not change — Medicare's coverage rules remain the same. However, waiting longer can sometimes mean the cataract becomes denser and harder to remove, which may require a longer surgery or a different surgical technique, potentially increasing your out-of-pocket cost if the surgeon charges more for a complex case.
If you have not yet met your Part B deductible for the year, you might want to schedule surgery early in the year so you can spread your deductible across multiple services. But this is a minor consideration — the main reason to schedule is when your vision loss is affecting your safety or quality of life.
Costs for both eyes
Medicare covers cataract surgery on each eye separately. You will have two separate surgeries, usually scheduled a week or two apart. This means you will pay your out-of-pocket costs twice — once for each eye. If you have already met your Part B deductible when you have the first eye done, you will owe only 20 percent coinsurance for the second eye (no second deductible).
If both surgeries happen in the same calendar year and you have not met your deductible, you will owe the full deductible for the first eye and then 20 percent for the second. If the surgeries fall in different calendar years, you will owe the deductible twice.
Questions to ask your surgeon's office before surgery
Call your surgeon's office at least two weeks before your scheduled surgery and ask these questions in writing (email is best, so you have a record):
- Do you accept Medicare assignment for cataract surgery?
- What is the Medicare-approved amount for the surgeon's fee?
- Where will the surgery take place (hospital, ambulatory surgery center, or office)?
- What is the facility copay or coinsurance amount?
- What intraocular lens options are available, and which are covered by Medicare at no extra charge?
- Do you need prior authorization from my insurance plan before surgery?
- What is my total estimated out-of-pocket cost?
If you have Medigap or Medicare Advantage, also contact your insurance plan and ask what they cover for cataract surgery at the specific facility where your surgeon operates. Plans sometimes have different coverage rules for different facilities.
Frequently Asked Questions
Does Medicare cover the cost of eyeglasses or contact lenses after cataract surgery?
No. Medicare covers the surgery and the intraocular lens, but not the eyeglasses or contact lenses you may need afterward to fine-tune your vision. You pay for these out of pocket. Some Medicare Advantage plans include a vision benefit that covers glasses, but Original Medicare does not.
What if I choose a premium intraocular lens?
Medicare covers a standard monofocal intraocular lens. If you choose a multifocal lens (which reduces the need for reading glasses) or a toric lens (which corrects astigmatism), you pay the difference between the cost of the standard lens and the premium lens out of pocket. This is usually $500 to $3,000 per eye, depending on the lens type and surgeon. Ask your surgeon for the exact upgrade cost before surgery.
Do I need prior authorization from Medicare before cataract surgery?
No. Original Medicare does not require prior authorization for cataract surgery. However, if you have a Medicare Advantage plan, your plan may require it. Contact your plan before scheduling to confirm whether authorization is needed.
What if my surgeon is out of network for my Medicare Advantage plan?
If you use an out-of-network surgeon with a Medicare Advantage plan, you may owe significantly more out of pocket, or the plan may not cover the surgery at all. Always confirm your surgeon is in-network before scheduling. If you prefer an out-of-network surgeon, you can switch to Original Medicare during the annual enrollment period (October 15 to December 7), but this takes time and does not cover surgery scheduled before the switch takes effect.
Can I have cataract surgery at a specific facility to lower my costs?
Possibly. Ambulatory surgery centers sometimes charge less than hospital outpatient departments for the same surgery. Ask your surgeon whether they perform cataract surgery at multiple facilities and what the facility cost would be at each. If your surgeon operates at both a hospital and an ambulatory surgery center, the surgeon's fee is the same, but the facility copay or coinsurance may differ.