If cataracts are clouding your vision, you’re not alone. Over 50% of Americans develop cataracts by age 80. So does Medicare cover cataract surgery?
The good news? Medicare covers cataract surgery when it’s medically necessary. But costs depend on your plan, lens choices, and where you get treated.
Here’s exactly what’s covered and what you’ll pay.
Short Answer: Yes, it does cover cataract surgery.
Medicare Part B (Medical Insurance) covers:
Medicare Part D helps pay for prescription medications you’ll likely need before and after surgery. Copays apply, and coverage depends on your specific plan’s formulary. Always check your plan details.
It covers:
Medicare Advantage plans are required to cover everything Original Medicare does, but with their own rules.
Here's a critical tip. Call your plan to confirm costs, required documentation, and approved providers before your procedure.
On the other hand, here are a few costs that Medicare does NOT cover:
| Service | Coverage |
| Premium Lens Implants (Toric, multifocal, etc.) | ❌ You pay 100% of the upgrade cost ($1,000-$4,000+/eye) |
| Eyeglass upgrades (premium frames, coatings) | ❌ Not covered |
| Corrective surgeries (LASIK/PRK) | ❌ Excluded |
| Routine eye exams for glasses | ❌ Not covered |
Understanding the costs involved with cataract surgery can help you plan ahead and feel more confident about your healthcare decisions.
While Medicare Part B covers a significant portion of your procedure, there are still cataract surgery out-of-pocket costs to consider.
Medicare Part B requires a deductible of $240 per year (as of 2024). This amount must be paid before your Medicare coverage begins to share in the costs of your care.
Once you've met your deductible, you're generally responsible for 20% of the approved Medicare Part B eye surgery. For example, if Medicare approves $1,000 for your procedure, you may owe $200 out of pocket.
The cost of cataract surgery can vary depending on where the procedure is performed:
These estimates include your share of the procedure, facility, and related services after Medicare pays its portion.
Medigap (Medicare Supplement Insurance) plans may help reduce or eliminate these out-of-pocket costs by covering the deductible, coinsurance, and other expenses. If you have a Medigap plan, your financial responsibility may be significantly lower.
Thinking about upgrading to Toric IOLs for astigmatism or multifocal lenses? Medicare won’t cover these.
Patients pay the entire upgrade cost, which can range from $1,000 to $4,000 per eye. Medicare only covers a basic monofocal lens implant.
Medicare helps ensure your new vision is supported with appropriate lenses to match your implanted intraocular lens (IOL). Therefore, this program covers one pair of basic eyeglasses or contacts after cataract surgery.
This coverage applies even if you’ve never needed glasses before surgery.
You Pay:
Here's a helpful tip: Medicare will usually cover the glasses if purchased from a Medicare-approved supplier. Be sure to ask your provider or surgical center for a referral or check Medicare.gov to find a participating eyewear provider in your area.
Cataract surgery is usually covered by Medicare, but unexpected costs can still happen. These simple steps will help you ask the right questions and understand what you’ll need to pay, so you’re not caught off guard.
Medicare only covers cataract surgery if it’s considered medically necessary. That means your vision must be affecting your daily life, like making it hard to drive, read, or recognize faces. Your eye doctor needs to note this in your medical record.
Tip: Ask your doctor, “Will Medicare cover this surgery?” and make sure they’ve documented why it’s needed.
This is one of the most important questions you can ask. If your doctor accepts Medicare assignment, they agree to take the Medicare-approved amount as full payment. You’ll only pay your share, usually 20%. If they don’t, you could be billed more.
Tip: Don’t forget to ask this about the surgical center and the anesthesiologist, too, not just the eye doctor.
With Medicare Advantage vision coverage, your plan may have its list of approved doctors and hospitals. Even if your surgeon accepts Medicare, they must also be in your plan’s network. Most plans also require approval before surgery.
Tip: Call your insurance company and ask, “Is my surgeon in-network? Do I need approval before surgery?”
Ask your doctor or surgical center for a written estimate before the procedure. This should list what’s covered and what’s not. This is especially if you’re thinking about getting a premium lens upgrade, like a multifocal or toric lens. Remember, Medicare usually only covers basic (monofocal) lenses.
Tip: Ask them to break it down: What’s included with Medicare? What will I have to pay out-of-pocket?
Request a written estimate that outlines:
After surgery, you’ll probably need eye drops to prevent infection and help with healing. These prescriptions may not be fully covered by your drug plan (Part D or Medicare Advantage).
Tip: Ask your pharmacist or plan provider:
If Medicare denies your cataract surgery claim:
Navigating Medicare coverage for vision surgery doesn’t have to be stressful. At Texas Vision & Laser Center, we walk you through every step, from insurance verification to post-op care. We’re proud to provide cataract surgery in North Texas while offering expertise and compassionate care.
Book an Assessment Now and let us help you see clearly again, with confidence and peace of mind.
Disclaimer: This article is for informational purposes only and is not a substitute for medical or insurance advice. Coverage and costs may vary based on your individual Medicare plan.
