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Does Medicare cover cataract surgery and implants?

8 answers | Last updated: Oct 21, 2014
An anonymous caregiver asked...
Does Medicare pay for cataract surgery?

Caring.com User - Joseph L.  Matthews
Caring.com Expert
Joseph L. Matthews is a Caring.com Expert, an attorney, and the author of Long-Term Care: How to Plan & Pay for It and...
75% helpful

Yes, it does. Because cataract surgery is performed by a physician rather than an optometrist, Medicare Part B See also:
Medicare Explained

See all 119 questions about Vision Problems
covers the surgery, including lens implants. And following that surgery, it can pay its share for one pair of eyeglasses. How much it pays for the glasses depends on whether you get new frames, and if so how much they cost. Medicare Part B will pay for both lenses and frames, but only basic frames. If you buy more expensive frames than the basic ones approved by Medicare, you'll have to pay out of pocket for the difference between the standard amount Medicare pays and the amount your frames actually cost.

For both the surgery and the glasses, you have to pay a coinsurance amount, which is 20 percent of the amount Medicare approves for the surgical procedure and for the glasses and frames. Before you choose new glasses after your surgery, make sure to let the doctor's or optometrist's office -- depending on which one you are ordering your glasses from -- know that you want the bill for your glasses sent to Medicare, and ask what frames they have that are fully covered by Medicare (not counting your 20 percent coinsurance amount).


More Answers
55% helpful
RIC answered...

As to the cataract article (Cataract expenses covered by Medicate), there is more information needed. My eye specialist has told me if the patient wants more than the standard, medicare paid for intraocular lense, the different is paid by the patient. To get an "accommodating" lense (such as Crystalens (made by Bauch and Lomb), there is a large out of pocket expense. However the patient will not need the use of eyeglasses, 90 percent of the time. The Crystalens accommodates the lenses so the patient can see close, near by, and distance subjects. They claim their lense acts like a the original, biological lense we were born with.


17% helpful
jacasa answered...

I have medicare and a supplemental healthcare plan. Imagine my surprise when I found out medicare does NOT approve the anesthetic used during cataract surgery. Since medicare doesn't cover, the supplemental won't pay a dime. My question for medicare would be, who in the world would have the lens of their eye sliced off without the eye being numb? I was wide awake for the procedure, no other anesthetic was given.


27% helpful
OUCH! answered...

Just assisted my mom - one special implant (Toric)- one not. Out of pocket was about $2500 total for both eyes . One Rx of eye drops (there are 3 different eye drops for pre & post op) was $175 PER OUNCE - no generics available - she needed 2 complete sets (one for each eye). Toric lens costs $900 that Medicare paid zero on. Be prepared - " Medicare pays 100% of nothing" is the best advice we were given. Will spend over $500 for eye drops alone - not covered. Bring your wallet (Oh, btw, needed the money upfront before the surgeon would do the surgery!) Good news - she now has a better quality of life and (hopefully) no more glasses.


67% helpful
Patriot47 answered...

The best thing to do is make sure that your opthalmalogist gives you the amt of monies before you do anything.. Yes..it is going to cost you more for the non standard eye lenses, but that is your option not normal. Your vision will improve completely..but not to the tune that you don't use glasses. In any eye surgery the opthalmalogist that performs your surgery usually includes a package given to you with eye drops you will need. These are furnished to you by the surgeon that performs the surgery.. Insure that this is part of the surgery.. Many surgeons.. (eye surgeons) will issue you a kit for after surgery.. Bottom line.. get your total of monies out of pocket before you do anything.. or you will wind up paying or not having the procedure done.. With any insurance.. medicare or other,.. your cost for a standard cataract surgery will be 500-550 per eye.. unless you choose.. crystalens.. then you can expect to pay.. 1200+..and the best thing to do is ask your Dr. (surgeon) for sample eye drops.. all of them will give you samples.. why pay.. more?


14% helpful
An anonymous caregiver answered...

in general the answer is somewhere between the extremes in the other answers above.

Patriot47 has it pretty accurate except that I would find it unusual -- but not impossible -- that the the surgeon would provide free eye drops given that he or she operates on about 500 cataract patients a year (and would go broke giving them to everyone free). The eye drops are covered by Part D but are brandname and therefore expensive (as someone else noted). But my eye drops were $100 under Part D, not $500 as someone claimed.

And of course Medicare pays for anesthesia. Perhaps the anesthesia doctor used (probably selected by the clinic or the hospital, not the surgeon) might not have accepted Medicare. Or... I dunno... sounds fishy.


An anonymous caregiver answered...

I priced out the 4 drugs my brother was instructed to take for his cataract surgery. 2014 prices under Medicare Part D providers ran about $750 to just under $1000. Way to much money for people on social security. Heaven help them if a second bottle is needed. So much stress for the retirees. I thought health expenses would improve under the Affordable Care Act.


14% helpful
JeanMY answered...

My Mom had the Toric 10L put in 2 years ago and paid $500 to the Dr. for the lens. She's having the other eye done next month (different Dr.) and the he wants $550, plus another $350 for the hospital. I'm trying to figure out why the hospital gets $350 for ordering the lens. Does this sound reasonable? I know the hospital will bill again for the use of their space, as will the Dr. for the surgery. Just doesn't make sense that they can both charge for the lens.


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