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Does Medicare Pay for Cataract Surgery?

July 30, 2017

By age 80, more than half of all Americans either have a cataract or have had cataract surgery, according to the National Eye Institute. This surgery is one of the most common procedures performed in the United States, and if you're a candidate, you may wonder if Medicare pays for cataract surgery.

Medicare covers many medically necessary surgical procedures, and cataract surgery is considered one of them.

Don't Wait to Get Your Covered Cataract Surgery

If you’ve been diagnosed with cataracts in both eyes and advised to have surgery, it will usually be done on each eye separately. Your eye surgeon will typically wait four weeks between surgeries.

Even if you think you can wait for surgery, ophthalmologists recommend you do the surgery sooner rather than later. That’s because as you age, lenses actually harden, so replacing them becomes more difficult for your doctor.

Medicare not only pays for cataract surgery, but also for a set of prescription eyeglasses or contact lenses following your surgery. You will be responsible for additional charges for upgrading your frames from “basic” frames.

Determine Your Cataract Surgery Costs

As with any surgery or procedure, you may not know exactly what everything is going to cost until you meet with your health care team and they determine what you need. You can do some advance planning and estimate your costs by determining whether:

  • You’ll be inpatient or outpatient, since inpatient costs more
  • Your other insurance might pay, including Medicare Advantage and Medicare Supplement Plans (Medigap)
  • You’ve met your deductibles for Part A, your hospital insurance, and Part B, your medical insurance, or Medicare Advantage, which includes both. If not, you’ll pay those before Medicare pays for cataract surgery and you may still have to pay copayments.

There's plenty of helpful information at our Medicare page to help you decide which plans and options are best for you.

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A CONSUMER’S GUIDE TO HEALTH INSURANCE FOR PEOPLE ELIGIBLE FOR MEDICARE MAY BE OBTAINED FROM YOUR LOCAL SOCIAL SECURITY OFFICE OR FROM THIS INSURER

Empire BlueCross BlueShield is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Services provided by Empire HealthChoice Assurance, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

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