Medicare covers most of the cost of cataract surgery, but you will pay a portion depending on which part of Medicare you have and whether your surgeon is in-network.

Original Medicare (Part A and Part B) covers cataract surgery as an outpatient procedure. Part B pays 80 percent of the approved amount after you meet your annual deductible. You pay the remaining 20 percent, plus your deductible. The exact dollar amount you pay depends on what your surgeon charges and whether they accept Medicare's approved amount as payment in full.

If you have a Medicare Advantage plan (Part C), your coverage and costs vary by plan. Some plans cover cataract surgery with a copay (typically $0 to $500), while others use coinsurance (a percentage of the cost). You need to check your specific plan's documents or call the plan directly to learn your out-of-pocket cost.

Medicare covers one pair of eyeglasses or contact lenses after cataract surgery if the surgery was performed by a Medicare-participating provider. This is a one-time benefit per eye.

Key Takeaways

  • Original Medicare covers 80 percent of cataract surgery costs after you pay your Part B deductible; you pay the remaining 20 percent.
  • Medicare Advantage plans have different cost structures — some use copays and others use coinsurance — so you must check your plan documents or call your plan to learn your exact cost.
  • Medicare covers one pair of eyeglasses or contact lenses per eye after surgery, but only if your surgeon participates in Medicare.
  • Using an in-network surgeon under Original Medicare means you pay 20 percent of Medicare's approved amount, not the surgeon's full charge.
  • Facility fees (the cost of the surgery center or hospital) are covered by Medicare Part A if the procedure is done in a hospital, or Part B if done in an outpatient surgery center.

How Original Medicare Calculates Your Cost

Under Original Medicare, the amount you pay depends on three things: the annual Part B deductible, the approved amount Medicare sets for the procedure, and whether your surgeon accepts Medicare assignment.

First, you pay your Part B deductible once per calendar year (the amount changes yearly). After you meet the deductible, Medicare pays 80 percent of the approved amount and you pay 20 percent. If your surgeon accepts Medicare assignment, they agree to charge no more than Medicare's approved amount, so your 20 percent is based on that lower figure. If your surgeon does not accept assignment, they can charge up to 15 percent more than the approved amount, which means your 20 percent bill could be higher.

To find out what you will pay, call your surgeon's office and ask: "What is your charge for cataract surgery, and do you accept Medicare assignment?" Then contact Medicare at 1-800-MEDICARE to learn the current approved amount for your area. Subtract the deductible, multiply the remaining approved amount by 0.20, and you have your estimated cost.

Medicare Advantage Plan Costs

Medicare Advantage plans are required to cover cataract surgery, but each plan sets its own cost-sharing rules. Some plans charge a copay per visit (ranging from $0 to $500 or more), while others charge coinsurance (a percentage of the total cost). A few plans cover the procedure with no out-of-pocket cost.

Your plan may also require you to use an in-network surgeon. If you see an out-of-network surgeon, your costs will be higher or the plan may not cover the procedure at all. Before scheduling surgery, call your plan's customer service number (on your insurance card) and ask: "What is my cost-sharing for cataract surgery, and which surgeons are in-network in my area?"

Some Medicare Advantage plans also cover the post-surgery eyeglasses or contacts, while others do not. This is another detail to confirm with your plan before the procedure.

What Is Included in the Surgery Cost

Medicare's payment for cataract surgery includes the surgeon's fee, the facility fee (whether the surgery center or hospital operating room), anesthesia, and standard post-operative care visits. The procedure typically involves removing the clouded lens and implanting an intraocular lens (IOL).

Medicare covers a standard IOL at no extra charge. If you choose a premium IOL — one designed to reduce your need for glasses after surgery — you will pay the difference between the standard lens and the premium lens out of your own pocket. This extra cost is not covered by Medicare and is not subject to your deductible or coinsurance. Premium IOLs can cost $500 to $3,000 per eye, depending on the type and your surgeon.

The post-operative eyeglasses or contact lenses are covered as a separate benefit. You receive one pair per eye, and the benefit covers the frames and lenses. You do not pay a copay or coinsurance for this benefit under Original Medicare; it is covered at 100 percent after your Part B deductible is met.

Timing and Pre-Surgery Steps

Before scheduling cataract surgery, you will have a pre-operative eye exam. This exam is covered by Medicare Part B (you pay 20 percent after your deductible). During this visit, your surgeon will measure your eye to determine the correct IOL power and discuss lens options with you.

If you are considering a premium IOL, ask your surgeon for a written estimate of the extra cost. This is not a Medicare charge, so it will not count toward your deductible or out-of-pocket maximum. Get the estimate in writing so you can decide before the day of surgery.

After surgery, Medicare covers follow-up visits for 90 days. These visits are part of the global surgical package, meaning they are included in the surgery cost and you do not pay separately for them (though you still pay your 20 percent coinsurance on the original surgery charge).

If You Have Both Original Medicare and a Medigap Plan

If you have Original Medicare plus a Medigap (supplemental insurance) plan, your Medigap plan may cover some or all of your 20 percent coinsurance. The amount depends on which Medigap plan you have. Plans G, F, and N typically cover a larger share of your costs than plans K or L.

To find out what your Medigap plan covers, call the insurance company listed on your Medigap card and ask: "What does my plan cover for cataract surgery?" Your Medigap plan will pay the insurance company directly, so you may not have to pay anything out of pocket if your plan covers the full 20 percent.

Frequently Asked Questions

Does Medicare cover cataract surgery in both eyes at the same time?

Medicare covers cataract surgery in both eyes, but surgeons typically perform the procedures on separate days — usually one to two weeks apart. This allows your first eye to heal before surgery on the second eye. Medicare will pay for both surgeries under the same rules.

What if I choose not to have cataract surgery — does Medicare cover other treatments?

Medicare does not cover glasses, contact lenses, or eye exams for refractive errors (nearsightedness, farsightedness, astigmatism). It covers cataract surgery and the eyeglasses or contacts after surgery, but not preventive eye care or non-surgical treatments for cataracts.

Will I owe anything if my surgeon is not a Medicare provider?

If your surgeon does not accept Medicare, you may owe the full cost of surgery out of pocket. Medicare will not pay a non-participating provider. Always confirm your surgeon accepts Medicare before scheduling.

Can I use my Medicare Advantage plan at any surgery center?

No. Medicare Advantage plans have networks, and you will pay more or receive no coverage if you use an out-of-network provider. Check your plan's provider directory or call customer service to confirm your surgeon is in-network before booking surgery.

Do I have to pay for the premium IOL upfront, or can I pay after surgery?

Payment terms for premium IOLs vary by surgeon and facility. Some collect payment before surgery, others bill you after. Ask your surgeon's billing office about their payment policy when you receive the written estimate for the premium lens cost.