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Does Medicare Cover Cataract Surgery & Eye Exams?

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In this article we’ll discuss:

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Want to know more about Medicare vision and what’s covered (and what’s not)? 

Let me guess. You’re probably wondering:

  • Does Medicare cover cataract surgery?
  • Does Medicare cover eye exams?
  • Does Medicare cover vision?

Good news — We’re going to answer all these questions about Medicare vision coverage, surgeries and more.

Does Medicare cover cataract surgery

Does Medicare Cover Cataract Surgery?

Does Medicare cover eye surgery? Medicare will cover your cataract surgery as long as it is done using traditional surgical techniques or using lasers. There are some basic requirements to qualify for cataract surgery. 

The Medicare requirements for cataract surgery are:

  • Your doctor must say that your cataract surgery is medically necessary.
  • The doctor that is treating you must accept a Medicare plan as payment.

Does medicare pay for cataract surgery?

The quick answer is yes. 

Your cataract surgery will be paid by Medicare, as long as your physician has determined that it’s a medically necessary surgery for you to live a healthy life.

Important: Make sure you check out the latest copy of the Medicare and You Handbook. You’ll be able to find the latest information on Medicare coverage.

How much does medicare pay for cataract surgery?

Cataract surgery can cost anywhere from around $3,600 to $6,000 per eye. Remember that Medicare pays 80% of the medical expenses that are surgery related. You will be responsible for the remaining 20% of these costs unless you have a Medicare Supplement.

Your Medicare plan pays for the following services:

  • preoperative exam
  • cataract removal
  • lens implantation
  • postoperative exam
  • postoperative prescription eyeglasses (1 pair)

Let’s review:

Your Medicare Part A provides coverage for your inpatient hospital stays. You will not require an overnight stay after your cataract surgery (typically). Now if you were to require a stay at the hospital (for example, if you had complications) Part A would provide coverage for these additional accommodation costs.

Medicare Part B provides coverage for preventative and medically necessary procedures. Cataract surgery is covered as well as certain post surgical costs.

medicare vision coverage

Since Medicare may pay for your cataract surgery, you may be also be wondering, “does Medicare pay for eye exams?”

There is no Medicare eye exam coverage. In other words, Medicare will not cover your eye exams (also referred to as eye refractions) for contact lenses or eyeglasses. You will pay 100% for your eye exams

does medicare cover glasses?

Does Medicare cover eyeglasses? Typically, Medicare will not provide coverage for your prescription eyeglasses. The only exception is for the one pair of glasses or contact lenses that you get once you complete your cataract surgery.

Frequently Asked Questions

Is cataract surgery covered by medicare if it is done with a laser? Yes, as long as it meets the basic requirements for cataract surgery. 

Although Medicare will typically pay for cataract surgery, Medicare typically does not pay for eyeglasses. The exception is one pair after cataract surgery.

Original Medicare (Part A and Part B) typically doesn't provide coverage for routine eye exams for contact lenses or eyeglasses. However, if you are at high risk for glaucoma or have been diagnoses with diabetes, your Part B will provide coverage every 12 months for an annual eye exam.

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Questions?

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