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Does Medicare Cover Cataract Surgery?

"Does Medicare Cover Cataract Surgery?" Text over image of man undergoing eye exam.

Just the Essentials…

  • Cataracts are a common problem for older adults, and treatment or surgery to remove them is usually considered a medically necessary procedure.

  • Original Medicare generally does not cover corrective vision care needs, but cataract surgery is usually an exception to this rule.

  • If you require additional coverage for healthcare treatments related to your vision, like eyeglasses, contacts, or eye exams, a more comprehensive Medicare Advantage plan may be a good fit for you.

  • The licensed insurance agents and MedicareInsurance.com are more than willing to help you research and compare your options when it comes to Medicare Advantage plans. Give us a call today to get started!

What is the importance of vision care for older adults?

Unfortunately, it is practically common knowledge that our sense of vision is often one of the first to go as we age. In fact, According to the National Eye Institute, the older a person is, the higher their risk of developing common eye diseases such as age-related macular degeneration (AMD), glaucoma, and cataracts.

Experts estimate that approximately one in three Americans over the age of 65 is currently suffering from some form of vision-reducing eye disease. Unfortunately, this vision impairment has been shown to decrease one’s ability to perform daily activities and may even lead to an increased risk of depression in some cases.

For this reason, it is extremely important to take the proper steps to ensure that your vision is well maintained as you age.

What are cataracts?

A cataract is a clouding of the lens in the eye (the clear part of your eye that helps to focus light and images on the retina) that has the potential to drastically affect your vision. Unfortunately, cataracts are especially common in seniors. According to experts in the vision care field, by the age of 80, more than half of all Americans are either currently living with a cataract, or have undergone surgery to remove a cataract.

The lens of the eye is mostly made up of water and proteins that are precisely arranged in a way that allows light to pass through, helping you process images. As we age, however, these proteins have a tendency to degenerate and clump together, causing a small, cloudy area on the lens. This condition is called a cataract. If left untreated over time, cataracts will sometimes grow larger, clouding more of the lens and making it even harder to see. 

Researchers suspect that one’s risk of developing cataracts may increase if they are a smoker or if they suffer from diabetes, but it is commonly believed that cataracts are mostly a natural occurrence caused by the wear and tear that the delicate tissues of the eye are forced to endure throughout one’s life.

While the symptoms of early cataract development may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses, surgery is usually the most effective treatment for removing a cataract entirely. 

Does Medicare pay for cataract surgery?

Is cataract surgery covered by Medicare? That’s the big question for many seniors. Generally, Original Medicare Parts A and B do not cover preventive or routine vision care, but cataract surgery is often considered a medically necessary procedure under Medicare Part B. More specifically, Original Medicare Part B is likely to cover the following aspects of cataract treatment:

  • Surgical removal of the cataract
  • Basic lens implants
  • One set of prescription eyeglasses or contact lenses designed to assist recovery after surgery

It is important to note that Original Medicare will only cover the basics associated with cataract treatment. This means that while more advanced lens implants and recovery options may be available, you will be required to pay for those options out-of-pocket should you desire them.

Image of young eye doctor performing on exam on older man.

How can I get more comprehensive Medicare coverage for healthcare needs such as vision care?

Though many basic aspects of cataract surgery may be covered under Medicare Part B, more advanced options for treatment, recovery, or general vision care are typically not covered by Original Medicare alone, and this includes corrective lenses or contacts that are not prescribed as a direct result of cataract surgery.

Under Original Medicare, you will be asked to pay for 100 percent of the cost of non-covered services and 20 percent of the Medicare-Approved Amount for corrective lenses after each cataract surgery (though the Part B deductible does apply). Any costs associated with upgraded frames or out-of-network suppliers will not be covered by Original Medicare.

Luckily, it is still possible to upgrade your health insurance plan to include coverage for routine vision care, eye exams, eyeglasses, and contacts even without the caveat of cataract treatment. Typically, this can be done by enrolling in a Medicare Advantage (Medicare Part C) plan that offers these benefits.

At MedicareInsurance.com, our experienced staff of licensed insurance agents can help you research and compare your local options for Medicare Advantage coverage. Simply give us a call at (800) 950-0608 to get started today!

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