Medicare covers most of the cost of cataract removal, but you will pay a share of the bill

Medicare Part B covers cataract removal surgery as medically necessary care. You pay 20 percent of the approved amount after you meet your yearly Part B deductible. The surgeon's fee, the facility fee, and the anesthesia are all covered under this same 20 percent coinsurance — meaning your total out-of-pocket cost depends on what Medicare approves for your specific procedure and where you have it done.

The approved amount varies by region and by whether your surgery happens in a hospital outpatient department or an ambulatory surgery center. Medicare sets these amounts, and your surgeon's office can tell you what Medicare will approve for your procedure before you schedule. If your surgeon charges more than Medicare approves, you are responsible only for the 20 percent coinsurance on the approved amount, not the difference — that is a rule called limiting charges.

If you have a Medigap or Medicare Advantage plan, your coinsurance may be lower or covered entirely. Check your plan documents or call your plan to learn what you will owe.

Key Takeaways

  • Medicare Part B covers cataract removal surgery, and you pay 20 percent of the approved amount after meeting your yearly deductible.
  • The approved amount varies by region and facility type, so ask your surgeon's office what Medicare will pay before your surgery date.
  • If your surgeon charges more than Medicare approves, you owe only the 20 percent coinsurance on the approved amount, not the full difference.
  • Medigap and Medicare Advantage plans may lower or eliminate your coinsurance, so review your plan details before surgery.
  • Intraocular lens implants (the artificial lens placed during surgery) are covered by Medicare, including premium lens options if medically necessary.

The Medicare Part B deductible and how it affects your cost

Before Medicare pays anything, you must meet your yearly Part B deductible. For 2024, that deductible is $240, though the amount changes each year. Once you have paid $240 out of pocket for Part B services, Medicare begins to pay its share — in this case, 80 percent of the approved amount.

If you have already met your deductible earlier in the year for another service (such as a doctor visit or lab work), you will not pay it again for your cataract surgery. If you have not met it yet, your surgeon's office can tell you the approved amount so you can calculate what you will owe: the deductible plus 20 percent of the approved amount.

What the 20 percent coinsurance actually covers

The 20 percent you pay covers the entire surgical package: the surgeon's fee, the facility cost, anesthesia, and the intraocular lens implant. You do not pay separately for each item. Medicare approves a single total amount for the procedure, you pay 20 percent of that total, and Medicare pays 80 percent.

The intraocular lens — the artificial lens that replaces your clouded natural lens — is included in this coverage. If you choose a premium lens (such as a multifocal lens that reduces your need for glasses after surgery), Medicare covers the cost of a standard monofocal lens. You pay the difference between the standard lens and the premium lens out of pocket, in addition to your 20 percent coinsurance.

How to find out what your surgery will cost before the procedure

Call your surgeon's office and ask them to contact Medicare for the approved amount for your specific procedure code. They can usually provide this information within one business day. Write down the approved amount, subtract any deductible you still owe, and multiply the remainder by 0.20 — that is your estimated coinsurance.

If your surgeon's office cannot or will not provide the approved amount, you can call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and ask for the approved amount in your area for cataract removal. Have your surgeon's name and location ready. Medicare representatives can tell you the range of approved amounts for your region.

This estimate is not a may provide of your final bill — the actual approved amount may differ slightly — but it gives you a realistic picture before you commit to surgery.

Medigap and Medicare Advantage coverage for cataract surgery

If you have a Medigap plan (also called Medigap insurance), it may cover some or all of your 20 percent coinsurance. Plans C, D, F, G, M, and N all cover Part B coinsurance, meaning Medigap pays the 20 percent you would otherwise owe. Plans A, B, K, and L cover a portion of coinsurance. Check your plan documents or call your Medigap insurer to confirm what you will pay.

If you have a Medicare Advantage plan, your coinsurance for cataract surgery may be lower than 20 percent, or you may have a copay instead. Some Medicare Advantage plans cover cataract surgery with no coinsurance at all. Review your plan's summary of benefits or call your plan's customer service line to learn your exact cost.

Hospital outpatient versus ambulatory surgery center: does the location change your cost?

Cataract surgery can happen in a hospital outpatient department or in an ambulatory surgery center (a freestanding facility that specializes in same-day procedures). Medicare approves different amounts for the same surgery depending on the location — hospital outpatient departments typically have higher approved amounts than ambulatory surgery centers.

This means your 20 percent coinsurance will be higher if your surgery is at a hospital. Ask your surgeon whether the procedure can be done at an ambulatory surgery center, and ask what the approved amount is at each location. The difference can be several hundred dollars in your out-of-pocket cost.

What happens if your surgeon charges more than Medicare approves

Medicare sets an approved amount for each procedure in each region. If your surgeon charges more than that amount, they cannot bill you for the difference — this is called the limiting charge rule. Your surgeon must accept Medicare's approved amount as full payment for the service, minus your 20 percent coinsurance.

Before surgery, confirm with your surgeon's office that they accept Medicare assignment, meaning they agree to accept Medicare's approved amount. Nearly all surgeons who perform cataract surgery do, but it is worth verifying in writing before your procedure date.

Frequently Asked Questions

Do I have to pay anything out of pocket if I have a Medigap plan?

If your Medigap plan covers Part B coinsurance (plans C, D, F, G, M, or N), Medigap will pay your 20 percent coinsurance after you meet your Part B deductible. You may still owe the deductible itself, depending on your plan. Check your plan documents or call your Medigap insurer to confirm.

What if I choose a premium intraocular lens?

Medicare covers the cost of a standard monofocal lens. If you choose a multifocal, toric, or other premium lens, you pay the difference between the standard lens cost and the premium lens cost out of pocket, in addition to your regular 20 percent coinsurance on the approved amount.

Can I have cataract surgery on both eyes in the same visit?

Cataract surgery is typically done on one eye at a time, usually several weeks apart. If both eyes are done on the same day, Medicare counts this as two separate procedures, and you pay 20 percent coinsurance for each eye. Your surgeon can explain the medical reasons for spacing the surgeries.

Does Medicare cover the cost of glasses or contacts after cataract surgery?

Medicare does not cover eyeglasses or contact lenses after cataract surgery, even if you need them because of a refractive error from the surgery. You will need to pay for these out of pocket or through a separate vision plan if you have one.

What if my cataract surgery is deemed not medically necessary?

Medicare covers cataract removal when it affects your vision enough to interfere with daily activities. If Medicare denies your surgery as not medically necessary, your surgeon's office can appeal the decision. Ask your surgeon to document how the cataract is affecting your vision and submit this with the appeal.