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

With Original Medicare (Parts A and B), Medicare pays 80 percent of the approved amount for cataract surgery once you have met your Part B deductible for the year. You pay the remaining 20 percent, called coinsurance. The exact dollar amount you owe depends on what your surgeon's office charges and what Medicare's approved amount is in your area — these vary by location and facility.

With a Medicare Advantage plan (Part C), your out-of-pocket cost depends entirely on your plan's rules. Some plans cover cataract surgery with a small copay; others require coinsurance similar to Original Medicare. You will need to check your plan's summary of benefits or call the plan directly to learn your specific cost.

Medicare covers the surgery itself, the facility fee, and the basic intraocular lens (IOL) that replaces your clouded natural lens. If you choose a premium lens — one that corrects astigmatism or allows you to see at multiple distances without glasses — you will pay the full difference between the basic lens and the premium lens out of your own pocket.

Key Takeaways

  • Original Medicare pays 80 percent of cataract surgery costs after you meet your Part B deductible; you pay 20 percent coinsurance.
  • Medicare Advantage plans vary widely in what they charge for cataract surgery, so you must check your individual plan's benefits.
  • Medicare covers the basic intraocular lens but not the full cost of premium lenses that reduce dependence on glasses.
  • Your actual out-of-pocket cost depends on your surgeon's charges, your area's Medicare-approved amount, and whether you choose a premium lens.
  • Cataract surgery is typically covered only when the cataract affects your vision enough to interfere with daily activities.

How the 20 percent coinsurance works in Original Medicare

After you pay your Part B deductible (which is the same for all beneficiaries and changes yearly), Medicare's approved amount for cataract surgery becomes the basis for payment. Let's say Medicare's approved amount in your area is $3,000. Medicare pays $2,400 (80 percent), and you owe $600 (20 percent).

However, if your surgeon's actual charge is higher than Medicare's approved amount, you are not responsible for the difference — that is called balance billing, and it is not allowed. Your surgeon's office should know Medicare's approved amount and bill accordingly. If you see an out-of-network surgeon who does not accept Medicare assignment, the rules change, and you should ask about costs before surgery.

The 20 percent coinsurance applies to the surgeon's fee, the facility fee (if surgery is at an outpatient surgery center or hospital), and anesthesia. Once you reach your annual out-of-pocket maximum for Part B (which varies yearly), Medicare covers 100 percent of remaining Part B services for the rest of that calendar year.

What Medicare Advantage plans typically charge

Medicare Advantage plans must cover cataract surgery because it is a Part B benefit, but they can structure the cost differently than Original Medicare. Some plans charge a copay — perhaps $250 to $500 per eye — regardless of the actual cost. Others use coinsurance, meaning you pay a percentage (often 20 percent, but sometimes 15 or 25 percent) of the plan's negotiated price.

A few Medicare Advantage plans cover cataract surgery with little or no out-of-pocket cost, especially if you use an in-network surgeon. Plans that offer this coverage often have higher monthly premiums. You should review your plan's "Summary of Benefits and Coverage" document, which lists what you pay for surgery, or call your plan's member services line to ask specifically about cataract surgery costs.

Some Medicare Advantage plans also cover the premium intraocular lens partially or fully, while others do not. This is another reason to check your plan's details before scheduling surgery.

Premium lenses and what you pay for them

Medicare covers the cost of a standard monofocal intraocular lens, which corrects distance vision. If you want a premium IOL — such as a multifocal lens (which allows you to see at multiple distances) or a toric lens (which corrects astigmatism) — you pay the full difference out of pocket.

The difference between a basic lens and a premium lens can range from $500 to $2,500 per eye, depending on the lens technology and your surgeon's pricing. This is a separate charge from the surgery itself and is not subject to Medicare's coinsurance rules — you pay the full amount if you choose it.

Before choosing a premium lens, ask your surgeon's office for the exact cost and what it includes. Some surgeons bundle the premium lens cost into a single fee; others bill it separately. Understanding the total cost helps you decide whether the benefit of reduced dependence on glasses is worth the expense for you.

When Medicare will not cover cataract surgery

Medicare covers cataract surgery only when the cataract is affecting your vision enough to interfere with your daily activities or work. If your cataract is mild and your vision is still good, Medicare considers surgery not medically necessary and will not pay for it.

Your eye doctor will document how much the cataract is affecting your vision during an eye exam. This documentation is what Medicare uses to determine whether surgery is covered. If your doctor recommends surgery but Medicare denies it as not medically necessary, you have the right to appeal the decision.

Medicare also does not cover cataract surgery if it is performed at the same time as other elective eye surgery, such as LASIK or refractive surgery, unless the other surgery is also medically necessary. Ask your surgeon's office whether any other procedures planned for the same visit might affect Medicare coverage.

How to find out your exact out-of-pocket cost

The most reliable way to learn what you will pay is to contact your surgeon's office and ask them to check your coverage. Provide them with your Medicare card information. They can tell you whether you have Original Medicare or Medicare Advantage, and they can look up what Medicare or your plan will pay in your area.

If you have Original Medicare, ask the surgeon's office whether they accept Medicare assignment. If they do, your cost is limited to the 20 percent coinsurance (after your deductible) on Medicare's approved amount. If they do not, ask for a written estimate of their full charge before you commit to surgery.

If you have Medicare Advantage, call your plan's member services number (on the back of your card) and ask about cataract surgery coverage. Have your plan name and member ID ready. Ask specifically whether your plan covers the basic lens fully, what your copay or coinsurance is, and whether you can use any surgeon or only in-network surgeons.

Supplemental insurance and cataract surgery costs

If you have a Medigap policy (supplemental insurance), it may cover some or all of your 20 percent coinsurance for cataract surgery. Medigap plans vary in what they cover, so check your policy documents or call your Medigap insurer to confirm. Some Medigap plans cover the full coinsurance; others cover a percentage.

Medigap does not cover the cost of premium intraocular lenses, because Medicare does not cover them. However, if you choose a premium lens and pay out of pocket, Medigap will not reduce that cost.

If you have both Original Medicare and Medicaid (dual coverage), Medicaid may help pay your coinsurance or deductible, depending on your state's rules. Contact your state Medicaid office or your local Area Agency on Aging to learn whether you may have access to for help with Medicare costs.

Frequently Asked Questions

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

Yes. You must meet your Part B deductible for the calendar year before Medicare begins paying its 80 percent share. Once you have paid the deductible, you then owe 20 percent coinsurance on the approved amount for surgery. If you have already met your deductible earlier in the year for another service, you do not pay it again for cataract surgery.

What if I have cataract surgery on both eyes?

Medicare covers surgery on both eyes, but each eye is treated separately for billing purposes. You will owe 20 percent coinsurance on each eye's approved amount. Some surgeons perform both surgeries on the same day; others schedule them weeks apart. Ask your surgeon's office how they bill for bilateral surgery and whether there are any cost savings for doing both at once.

Can I choose my surgeon, or does Medicare require me to use a specific one?

With Original Medicare, you can use any surgeon who accepts Medicare assignment. With Medicare Advantage, you must use an in-network surgeon to receive the plan's negotiated rate; using an out-of-network surgeon will cost you significantly more. Check your plan's provider directory or call member services to find in-network eye surgeons in your area.

What happens if my surgeon's bill is higher than Medicare's approved amount?

If your surgeon accepts Medicare assignment, they cannot bill you more than the 20 percent coinsurance on Medicare's approved amount. If they do not accept assignment, they can charge more, and you are responsible for the difference. Always ask whether your surgeon accepts Medicare assignment before scheduling surgery.

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

Medicare covers one pair of glasses or contact lenses after cataract surgery, but only if you had the basic monofocal lens implanted. This coverage is limited and does not explore if you chose a premium lens. The coverage is through a specific benefit, so ask your surgeon's office how to access it.