How Does Medicare Cover Cataract Surgery?

Medicare may cover cataract surgery if the procedure is considered medically necessary by a doctor. Even if Medicare covers cataract surgery, however, there are still some costs you may have to pay out of pocket.

Medicare Advantage (Medicare Part C) plans also cover cataract surgery that's deemed medically necessary. Medicare Advantage plans also feature an out-of-pocket spending limit each year, which Original Medicare (Part A and Part B) doesn't offer.

When does Medicare cover cataract surgery?

If the cataract surgery is performed as an outpatient procedure by a Medicare-approved doctor, it may be covered under Medicare Part B (medical insurance).

For medically necessary vision services that are covered under Medicare Part B, you typically pay 20 percent of the Medicare approved amount and Medicare pays 80 percent. Keep in mind that you must meet your Part B deductible ($198 per year in 2020) before Medicare will begin paying its share.

Before your surgery, speak with your doctor about how much you may have to pay out of pocket for the procedure and for aftercare.

Some Medicare Advantage plans cover routine vision care

Neither Medicare Part A or Medicare Part B cover routine vision care or eye exams.

Medicare Part B covers some diagnostic tests and treatments associated with vision care:

• Tests and treatment for macular degeneration, including certain injected drugs
• One glaucoma test every 12 months for people who are at high risk of developing glaucoma (such as people who have a family history of glaucoma or who have diabetes)
• One yearly exam for diabetic retinopathy

Medicare Advantage plans (Medicare Part C) are an alternative to Original Medicare that provide the same coverage as Medicare Part A and Part B combined in one plan.

Some Medicare Advantage plans may offer vision care, as well as dental care and prescription drug coverage.

If you wear glasses or have an eye condition that requires frequent visits to the optometrist, you may want to consider enrolling in a Medicare Advantage plan that includes vision coverage.

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