Medicare covers cataract surgery as an outpatient procedure, and you pay a portion of the cost through your deductible and coinsurance

Medicare Part B covers the surgery itself, the intraocular lens (the artificial lens implanted in your eye), and the surgeon's fee. You are responsible for your Part B deductible (which resets each year) and then 20 percent of the approved amount for the procedure. The facility where the surgery happens — usually an outpatient surgery center or hospital — is also covered under Part B, though you may owe a copay depending on the setting.

The exact amount you pay depends on whether you have Original Medicare alone, a Medigap policy, or a Medicare Advantage plan. Each covers the remaining costs differently. If you have not yet met your deductible for the year, you will pay the full approved amount until you do, then 20 percent after that.

Key Takeaways

  • Medicare Part B covers cataract surgery, the artificial lens, and the surgeon's fee, but you pay your annual deductible plus 20 percent coinsurance.
  • The surgery is performed as an outpatient procedure, so you do not stay overnight in a hospital.
  • A Medigap policy (Plan C, D, F, or G) can cover most or all of your coinsurance and deductible, reducing your out-of-pocket cost significantly.
  • Medicare Advantage plans have their own cost-sharing rules, often with copays instead of coinsurance, and you should check your plan documents before scheduling.
  • Routine eye exams to diagnose cataracts are covered, but glasses or contact lenses after surgery are not covered by Medicare.

How Medicare Part B pays for the surgery and lens

When your eye doctor determines you need cataract surgery, Medicare Part B covers the procedure at an approved facility. The surgeon removes your clouded lens and inserts an intraocular lens (IOL) — a permanent artificial lens that becomes part of your eye. Medicare covers the standard IOL implant at no additional charge to you beyond your regular cost-sharing.

If you choose a premium IOL — one that corrects astigmatism or allows you to see at multiple distances without glasses — Medicare covers only the cost of a standard IOL. You pay the difference out of pocket. That difference varies widely depending on the lens type and facility, so ask your surgeon's office for the exact cost before the procedure.

The approved amount for cataract surgery varies by geographic region and facility type. Your surgeon's office can tell you what Medicare approves in your area. Once you know that amount, subtract what you have already paid toward your Part B deductible that year, then you owe 20 percent of the remainder.

What you pay with Original Medicare alone

With Original Medicare and no supplemental coverage, you pay your Part B deductible first. For 2024, that deductible is $240, though this amount changes yearly. Once you meet the deductible, you pay 20 percent of the approved surgical fee and facility charges for the rest of the calendar year.

If the approved amount for your cataract surgery is $3,000, and you have not yet met your deductible, you pay $240 (the deductible) plus 20 percent of the remaining $2,760, which is $552. Your total out-of-pocket cost would be $792. If you had already met your deductible earlier in the year, you would pay only the $552 coinsurance.

After you reach the Part B deductible, you continue paying 20 percent coinsurance for any other Medicare-covered services for the rest of that year. There is no annual cap on how much you pay in coinsurance under Original Medicare.

How a Medigap policy reduces your costs

A Medigap policy (also called Medigap supplemental insurance) is sold by private insurance companies and is designed to cover costs that Original Medicare does not. Plans C, D, F, and G all cover your Part B coinsurance, meaning they pay the 20 percent you would otherwise owe. Plans C and F also cover your Part B deductible.

If you have Medigap Plan F, for example, the plan pays your $240 deductible and your $552 coinsurance. You pay nothing out of pocket for the surgery itself. With Plan G, you pay the $240 deductible yourself, but the plan covers the $552 coinsurance. With Plans D or high-deductible Plan G, you may have a small copay or coinsurance amount, so check your policy documents.

Medigap policies have monthly premiums that vary by age, location, and the plan letter you choose. Plans that cover the deductible (C and F) typically cost more per month than plans that do not (D and G). When deciding whether a Medigap policy makes sense for you, compare the monthly premium against what you expect to pay out of pocket for medical care in a year.

Medicare Advantage plan coverage and costs

If you are enrolled in a Medicare Advantage plan (Part C), that plan covers cataract surgery, but the cost-sharing rules are different from Original Medicare. Instead of a deductible and 20 percent coinsurance, most Medicare Advantage plans use copays — a fixed dollar amount you pay for the surgery. Copays for outpatient surgery typically range from $0 to $500, depending on your specific plan.

Some Medicare Advantage plans have an annual out-of-pocket maximum, which means once you have paid a certain amount in copays and coinsurance during the year, the plan covers 100 percent of approved services for the rest of that year. Original Medicare does not have this protection. Check your plan's Summary of Benefits or call the plan directly to find out your copay for cataract surgery and whether you have an out-of-pocket maximum.

Medicare Advantage plans may also require you to use doctors and facilities in their network. If your preferred eye surgeon is not in the network, you may pay more or have to choose a different surgeon. Confirm that your surgeon participates in your plan's network before scheduling.

What happens before and after surgery

Before surgery, you will have a comprehensive eye exam to confirm the cataract diagnosis and measure your eye for the correct lens power. Medicare covers this diagnostic exam under Part B. You pay your deductible and 20 percent coinsurance for the exam as well, unless you have Medigap or Medicare Advantage coverage that waives these costs.

After surgery, you will need prescription eye drops and follow-up visits with your surgeon to monitor healing. Medicare covers these follow-up visits as office visits, subject to your regular Part B cost-sharing. The eye drops themselves are prescription medications, and coverage depends on whether you have Part D (prescription drug coverage). If you do, your copay for the drops is determined by your Part D plan's formulary.

If you need glasses or contact lenses after surgery to correct your vision, Medicare does not cover them. You can purchase glasses or contacts from any provider, and some vision discount plans or retailers offer reduced prices for Medicare beneficiaries.

Timing and scheduling your surgery

Cataract surgery is not an emergency, so you can schedule it at a time that works for you. If you are early in the calendar year and have not yet met your Part B deductible, you might want to schedule surgery before the end of the year if other medical expenses are likely. Conversely, if you have already met your deductible, scheduling surgery later in the year means you pay only the 20 percent coinsurance.

If you are considering a Medigap policy, you can enroll during your initial enrollment period when you first turn 65 and sign up for Medicare. If you enroll in Medigap after that window, some insurers may deny coverage or charge higher premiums based on your health history. If cataract surgery is on your horizon and you do not yet have Medigap coverage, it may be worth exploring whether you can enroll.

Talk with your surgeon's billing office about the approved Medicare amount before your procedure. They can often estimate your out-of-pocket cost based on your coverage type and whether you have met your deductible. This estimate helps you plan financially and understand what to expect at the time of service.

Frequently Asked Questions

Does Medicare cover both eyes if I need cataract surgery on each one?

Yes. Medicare covers cataract surgery on both eyes, but they are typically done as separate procedures, usually a week or two apart. You will owe your cost-sharing for each surgery separately. If you have not met your deductible by the time of the first surgery, you will meet it then, so the second surgery will only require you to pay 20 percent coinsurance.

What if my eye doctor says I need a premium lens to see without glasses?

Medicare covers only a standard IOL implant. If you choose a premium lens that corrects astigmatism or allows multifocal vision, you pay the difference between the standard lens cost and the premium lens cost out of pocket. Ask your surgeon's office for an itemized quote before the procedure so you know the exact additional cost.

Do I need to get prior approval from Medicare before cataract surgery?

No. Cataract surgery is a covered procedure, and you do not need to request prior approval. Your surgeon's office will verify your Medicare coverage before scheduling, and they can tell you what Medicare approves for the procedure in your area.

If I have a Medicare Advantage plan, can I see any eye surgeon?

You should use a surgeon in your plan's network to pay the lower copay amount. If you see an out-of-network surgeon, you may pay significantly more or the plan may not cover the service at all. Check your plan's provider directory or call the plan to confirm your surgeon is in network before scheduling.

Are there any cataract surgeries that Medicare does not cover?

Medicare covers cataract surgery when the cataract is affecting your vision and your doctor determines surgery is medically necessary. If your cataract is very mild and not yet affecting your daily vision, your doctor may recommend waiting. Medicare will not cover surgery purely for cosmetic reasons or if the cataract is not yet causing functional vision loss.