Cataracts affect more than half of all Americans by age 80, according to the National Eye Institute. Cataract surgery is one of the most common procedures performed in the United States, with over 4 million surgeries annually.

Unlike many vision services, Medicare does cover cataract surgery—and it's one of Medicare's most utilized benefits. Understanding exactly what's covered helps you plan for the procedure with confidence.

Does Medicare Cover Cataract Surgery?

Yes, Medicare Part B covers cataract surgery when it's medically necessary. This includes the surgical procedure, one standard intraocular lens (IOL) per eye, post-surgical care, and corrective lenses after surgery. Medicare considers cataract surgery medically necessary when cataracts significantly impair your vision and interfere with daily activities.

Medicare Part A (Hospital Insurance)

Coverage: Limited role

Part A typically doesn't cover cataract surgery since it's usually performed as an outpatient procedure. However, if you needed cataract surgery while you were already hospitalized for a different reason and required an inpatient stay, Part A would cover the hospital costs.

For most people, cataract surgery happens in an ambulatory surgical center or hospital outpatient department, making Part B the relevant coverage.

Cost-sharing: If Part A applies (rare), you'd pay the Part A deductible plus any applicable coinsurance.

Medicare Part B (Medical Insurance)

Coverage: Comprehensive

Part B covers cataract surgery and related services:

Covered surgical services:

• Pre-operative examinations to determine if surgery is necessary

• The cataract removal procedure itself

• Insertion of one standard intraocular lens (IOL) per eye

• Facility fees for the surgical center or hospital outpatient department

• Anesthesia services

• Post-operative care and follow-up visits

Covered corrective lenses: Medicare covers one of the following after each cataract surgery:

• One pair of prescription eyeglasses with standard frames, OR

• One set of contact lenses

This benefit applies separately to each eye. If you have cataract surgery on both eyes at different times, Medicare covers new glasses or contacts after each surgery.

Medical necessity requirements:

Your eye doctor must document that:

• You have cataracts affecting your vision

• The cataracts interfere with your daily activities (reading, driving, working)

• Surgery will likely improve your vision

• Other treatments (like stronger glasses) won't adequately address the problem

Cost-sharing: You pay 20% of the Medicare-approved amount after meeting your Part B deductible. The surgical facility may also charge a copayment.

Medicare Part C (Medicare Advantage)

Coverage: Yes, must match Original Medicare

Medicare Advantage plans must cover everything Original Medicare covers, including cataract surgery. Some plans offer additional vision benefits like:

• Coverage for premium IOL upgrades (beyond what Original Medicare covers)

• Lower copays for the procedure

• Routine eye exams not covered by Original Medicare

• Allowances for eyeglasses beyond the post-surgical pair

Cost-sharing varies: Instead of the 20% coinsurance under Original Medicare, you might pay a fixed copay (often $100-$300 for outpatient surgery). Check your specific plan's benefits.

Medicare Part D (Prescription Drug Coverage)

Coverage: Post-operative medications

While Part D doesn't cover the surgery itself, it covers prescription medications your doctor prescribes after surgery, such as:

• Antibiotic eye drops to prevent infection

• Anti-inflammatory drops to reduce swelling

• Pain medication if needed

Your copay depends on your plan's formulary and which tier these medications fall under.

What Does Medicare Coverage for Cataract Surgery Include?

Medicare's cataract surgery coverage is comprehensive, but understanding exactly what's included helps you plan:

Pre-operative services:

• Comprehensive eye examination to diagnose cataracts

• Vision testing to document visual impairment

• Measurement of your eye to determine appropriate IOL power

• Medical clearance if you have other health conditions

Surgical procedure:

• Cataract removal using modern techniques (typically phacoemulsification)

• Insertion of standard monofocal intraocular lens

• Anesthesia (local or general, depending on your needs)

• Use of surgical facility and equipment

• Surgeon's professional fees

Standard intraocular lenses (IOLs):

Medicare covers one standard monofocal IOL per eye. These lenses:

• Correct vision at one distance (usually set for distance vision)

• Are highly effective and safe

• Require you to use reading glasses for close-up work

• Have been the standard of care for decades

Post-operative care:

Medicare covers all medically necessary follow-up care:

• Immediate post-operative visits (usually within 24-48 hours)

• Follow-up appointments to monitor healing

• Treatment for any complications

• Adjustments to your care plan if needed

Corrective lenses after surgery:

After your eye heals (typically 4-6 weeks), Medicare covers:

• One comprehensive eye exam to determine your new prescription

• One pair of prescription eyeglasses with standard frames, OR

• One set of contact lenses (if medically necessary)

This applies to each eye separately. If you have surgery on your right eye in January and left eye in March, Medicare covers corrective lenses after each procedure.

Frequency limitations:

There's no limit on how many times Medicare covers cataract surgery if medically necessary. If a cataract develops in your other eye later, or if you develop a secondary cataract (posterior capsule opacification), Medicare covers treatment.

Example scenario: Your ophthalmologist diagnoses cataracts in both eyes but recommends operating on the worse eye first. Medicare covers the pre-operative exam, the surgery on your right eye including a standard IOL, all follow-up care, and one pair of glasses once your eye heals. Three months later, you have surgery on your left eye. Medicare covers this procedure completely separately—another surgery, another IOL, and another pair of glasses if needed.

How Much Does Cataract Surgery Cost with Medicare?

Understanding your potential out-of-pocket costs helps you budget for the procedure:

Typical total out-of-pocket cost with Original Medicare:

For one eye with standard IOL: $500-$1,000 (including deductible, all coinsurance, and post-surgical glasses)

This assumes:

• You haven't met your Part B deductible yet

• You choose a provider who accepts Medicare assignment

• You select a standard monofocal IOL

• No complications require additional treatment

If you have Medigap (supplemental insurance):

Most Medigap plans cover your 20% coinsurance and may cover the Part B deductible, potentially reducing your out-of-pocket costs to near zero.

With Medicare Advantage:

Your costs depend on your specific plan:

• Copay for outpatient surgery: typically $100-$400 per eye

• May have separate copays for anesthesia: $25-$100

• Follow-up visits: usually $0-$40 per visit

• Total out-of-pocket often similar to Original Medicare but structured differently

Premium IOL upgrades:

If you choose a premium IOL instead of the standard lens, you pay the difference:

• Standard monofocal IOL: Fully covered by Medicare

• Premium multifocal IOL: You pay $1,500-$3,000+ extra per eye

• Premium toric IOL (corrects astigmatism): You pay $1,000-$2,500+ extra per eye

• Premium accommodating IOL: You pay $1,500-$3,000+ extra per eye

Medicare covers the cost equivalent to a standard IOL, and you pay the price difference for the upgrade. Your surgeon should provide clear pricing before you decide.

Cost example: If cataract surgery with a standard IOL has a Medicare-approved amount of $3,500 and you've met your deductible, you'd pay 20% ($700) and Medicare pays 80% ($2,800). If you choose a premium multifocal IOL that costs $2,000 more than the standard lens, your total out-of-pocket would be $2,700 ($700 coinsurance + $2,000 upgrade fee).

What To Do If You Want Premium IOL Upgrades

Standard IOLs work well for most people, but premium lenses offer additional benefits that some patients prefer. Here's how to approach premium IOL options:

Understanding premium IOL types:

Multifocal IOLs:

• Correct vision at multiple distances (near, intermediate, far)

• Reduce or eliminate need for reading glasses

• May cause glare or halos around lights, especially at night

• Best for people who want less dependence on glasses

Toric IOLs:

• Correct pre-existing astigmatism

• Provide clearer distance vision than standard IOLs if you have astigmatism

• Still require reading glasses for close work

• Good option if you have significant astigmatism

Accommodating IOLs:

• Move or change shape inside your eye to adjust focus

• Provide some intermediate and near vision

• Less dramatic than multifocal lenses

• Fewer night vision issues than multifocal lenses

Making the decision:

Have detailed discussions with your surgeon about:

• Your visual goals and lifestyle needs

• Whether you mind wearing glasses after surgery

• Your activities (night driving, computer work, reading)

• The additional cost and whether it fits your budget

• Potential side effects like glare or halos

Financial considerations:

• Premium IOLs add $1,000-$3,000+ per eye to your costs

• Medicare's contribution stays the same regardless of which lens you choose

• Ask your surgeon for written cost estimates before deciding

• Some surgeons offer payment plans for premium upgrades

• FSA/HSA funds can pay for premium IOL upgrades

Alternative options if premium IOLs aren't in your budget:

• Standard IOLs with reading glasses work excellently for most people

• Progressive or bifocal glasses can handle multiple distances

• Contact lenses (covered by Medicare post-surgery) offer another option

• Many people adjust well to using reading glasses after cataract surgery

How Aviator Health Can Help

Cataract surgery is a major procedure, and navigating coverage while managing your overall healthcare can feel overwhelming. An Aviator Health advocate can support you through:

Understanding your out-of-pocket costs: Your advocate can help you calculate what you'll actually pay based on whether you've met your deductible, what type of Medicare coverage you have, and whether you're considering premium IOL upgrades. They'll help you understand the difference between Medicare Advantage copays and Original Medicare coinsurance so you can budget appropriately.

Verifying coverage requirements: Some Medicare Advantage plans require prior authorization for cataract surgery. Your advocate can help ensure your surgeon's office submits the necessary paperwork and follows up if there are any delays or issues with authorization.

Coordinating with other health conditions: If you have diabetes, high blood pressure, or take blood thinners, cataract surgery requires extra coordination between your eye surgeon, primary care doctor, and specialists. Your advocate ensures everyone communicates effectively about medication adjustments, blood sugar management, and surgical clearance.

Choosing between Medicare Advantage and Original Medicare: If you're approaching Annual Enrollment and considering switching plans, your advocate can help you understand how the change would affect your cataract surgery costs and timing. Should you have surgery before or after switching? They'll help you make an informed decision.

Navigating post-surgical complications: While cataract surgery is very safe, complications occasionally occur. If you experience issues like infection, inflammation, or vision problems after surgery, your advocate helps coordinate care, ensure proper billing, and verify that follow-up treatments are covered.

Selecting and obtaining post-surgical eyeglasses: Your advocate can help you understand what's covered for your post-surgical glasses, find participating optical providers, and ensure you get the benefit you're entitled to.

Frequently Asked Questions

Q: Does Medicare Advantage cover cataract surgery differently than Original Medicare?

A: Medicare Advantage plans must cover cataract surgery since Original Medicare covers it, but they structure costs differently. With Original Medicare, you pay 20% coinsurance of the Medicare-approved amount plus your Part B deductible if you haven't met it. With Medicare Advantage, you typically pay a fixed copay for outpatient surgery (often $100-$400) regardless of the total procedure cost. Some Medicare Advantage plans offer extra vision benefits like coverage toward premium IOL upgrades or reduced copays for follow-up care. However, you'll need to use in-network providers with Medicare Advantage, while Original Medicare lets you see any doctor accepting Medicare. Compare the total estimated out-of-pocket costs between plans, not just the advertised copay amount.

Q: Do I need a referral for Medicare to cover cataract surgery?

A: With Original Medicare, you don't need a referral to see an ophthalmologist or have cataract surgery. Your eye doctor can directly evaluate you and recommend surgery if appropriate. However, with Medicare Advantage plans—especially HMO plans—you may need a referral from your primary care doctor before seeing an eye specialist. PPO Medicare Advantage plans typically don't require referrals. Check your plan's requirements before scheduling appointments. Even without a referral requirement, many people see their primary care doctor first to discuss their vision concerns and get recommendations for trusted eye surgeons.

Q: How often does Medicare cover cataract surgery?

A: Medicare covers cataract surgery as often as medically necessary without frequency limits. If you develop cataracts in one eye now and the other eye five years later, Medicare covers both surgeries. If you develop a secondary cataract (posterior capsule opacification) months or years after the original surgery, Medicare covers a laser procedure called YAG capsulotomy to treat it. Each procedure is evaluated based on medical necessity. Your eye doctor determines when surgery is appropriate based on how much the cataracts impair your vision and affect your daily activities. Medicare doesn't impose arbitrary waiting periods or limit how many times they'll cover the procedure.

Q: Will Medicare cover cataract surgery if it's not medically necessary?

A: No, Medicare only covers cataract surgery when it's medically necessary—meaning the cataracts significantly impair your vision. Your ophthalmologist documents medical necessity by showing that: cataracts interfere with your ability to perform daily activities like reading, driving, or working; your vision can't be adequately corrected with glasses or contact lenses; and surgery will likely improve your functional vision. If you have very early cataracts that barely affect your vision, Medicare won't cover surgery yet. Your doctor typically recommends waiting until cataracts substantially impact your quality of life. Medicare considers early-stage cataract removal without significant vision impairment to be elective and won't provide coverage.

Q: Does Medicare cover both eyes if I need cataract surgery on both?

A: Yes, Medicare covers cataract surgery for both eyes, but typically not at the same time. Surgeons usually operate on one eye first, let it heal for several weeks, then operate on the second eye. This approach is safer and allows your doctor to monitor healing and adjust the procedure for the second eye if needed. Medicare covers each surgery separately with full benefits—meaning you get a standard IOL for each eye and can get new prescription glasses after each surgery if your vision changes. Your out-of-pocket costs apply to each surgery separately, so you'd pay your 20% coinsurance twice. However, you only pay the Part B deductible once per year, not for each surgery.

Q: Can I get premium IOL coverage with a Medigap plan?

A: No, Medigap plans don't extend coverage to premium IOL upgrades. Medigap (Medicare Supplement Insurance) helps pay the out-of-pocket costs for services that Original Medicare already covers—like your 20% coinsurance for cataract surgery with a standard IOL. Since Medicare doesn't cover the additional cost of premium IOLs, there's no coinsurance for Medigap to cover. If you choose a premium multifocal or toric IOL, you pay the full upgrade fee out-of-pocket, even with Medigap. However, Medigap will still cover your 20% coinsurance for the standard IOL portion that Medicare approves. This means Medigap significantly reduces your out-of-pocket costs for the surgery itself, just not for elective lens upgrades.

Q: What do I need to do to ensure Medicare covers cataract surgery?

A: To ensure Medicare covers your cataract surgery, follow these steps. First, choose an ophthalmologist who accepts Medicare assignment—this prevents surprise bills from providers charging more than Medicare's approved amounts. Second, make sure your doctor documents that surgery is medically necessary in your medical records. Third, if you have Medicare Advantage, verify whether you need prior authorization and ensure your surgeon's office submits it. Fourth, confirm the surgical facility is Medicare-certified. Fifth, understand that Medicare covers only standard monofocal IOLs—if you want premium lenses, get written cost estimates for the upgrade. Sixth, ask your surgeon's office for a pre-surgery cost estimate showing your expected out-of-pocket expenses. Finally, after surgery, review your Medicare Summary Notice to verify Medicare paid correctly.

How to Get Cataract Surgery Covered by Medicare

Following these steps ensures smooth coverage and minimizes surprise costs:

Step 1: Schedule a comprehensive eye exam

See an ophthalmologist if you're experiencing vision changes, cloudiness, difficulty with night driving, or other symptoms of cataracts. Medicare Part B covers this diagnostic exam to determine whether you have cataracts and if surgery is needed.

Step 2: Confirm medical necessity with your doctor

If your doctor diagnoses cataracts, discuss how they're affecting your daily life. Your doctor needs to document that the cataracts significantly impair your vision and interfere with normal activities. This documentation establishes medical necessity for Medicare coverage.

Step 3: Verify your surgeon accepts Medicare

Before scheduling surgery, confirm your ophthalmologist accepts Medicare assignment. Providers who accept assignment agree to Medicare's approved amounts, protecting you from higher bills. You can search for Medicare providers at Medicare.gov or by calling 1-800-MEDICARE.

Step 4: Understand your lens options

Discuss whether a standard monofocal IOL (covered by Medicare) meets your needs or if you want a premium IOL upgrade. Get written cost estimates for any upgrades you're considering. Make sure you understand exactly what you'll pay out-of-pocket.

Step 5: Check prior authorization requirements

If you have a Medicare Advantage plan, call member services to ask whether cataract surgery requires prior authorization. If so, ensure your surgeon's office submits the authorization request well before your scheduled surgery date.

Step 6: Get a cost estimate

Ask your surgeon's billing office for a written estimate of your out-of-pocket costs, including:

• Surgeon fees and your 20% coinsurance

• Facility fees and your coinsurance

• Anesthesia costs and your coinsurance

• Any premium IOL upgrade fees

• Estimated costs for post-surgical care and glasses

Step 7: Prepare for surgery

Follow your surgeon's pre-operative instructions. Arrange transportation since you can't drive after surgery. Bring your Medicare card to all appointments. Keep copies of any paperwork related to authorization or cost estimates.

Step 8: Attend all follow-up appointments

Medicare covers all medically necessary post-operative care. Attend every scheduled follow-up visit to ensure proper healing and address any complications early.

Step 9: Get your post-surgical eyeglasses

Once your eye heals (typically 4-6 weeks after surgery), schedule an eye exam to determine your new prescription. Medicare covers one pair of prescription glasses with standard frames or contact lenses after cataract surgery.

Step 10: Review your Medicare Summary Notice

Check your MSN after surgery to verify Medicare paid correctly and confirm you're only being billed for your coinsurance. If anything looks wrong, contact your provider's billing office and Medicare.

Takeaway

Medicare Part B provides comprehensive coverage for cataract surgery when it's medically necessary, making this sight-restoring procedure accessible to millions of Americans. Unlike many vision services, cataract surgery is one of Medicare's core benefits.

Your out-of-pocket costs typically range from $500-$1,000 per eye with Original Medicare, or a fixed copay of $100-$400 with Medicare Advantage. If you have Medigap supplemental insurance, your costs may be even lower. These expenses cover everything: the surgery itself, a standard intraocular lens, all follow-up care, and one pair of prescription glasses.

Disclaimer: This article provides general information about Medicare cataract surgery coverage and should not be considered medical or financial advice. Medicare coverage rules and costs change annually. Always verify current coverage details with Medicare.gov or by calling 1-800-MEDICARE. Consult with your healthcare providers and licensed insurance agents to make decisions appropriate for your individual situation.