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Does Medicare cover cataract surgery?

Dear Marci,

Does Medicare cover cataract surgery?

-Bonnie (Missoula, MT)

Dear Bonnie,

Medicare generally does not pay for vision care, but it will cover certain medically necessary services, such as cataract surgery. If you have Original Medicare, these services are covered under Part B, which covers outpatient services. Medicare Advantage Plans cover the same services as Original Medicare, but may have different costs and conditions. If you have a Medicare Advantage Plan, contact a plan representative to learn about how the plan covers cataract surgery.

Specifically, Medicare covers:

  • The removal of the cataract
  • Basic lens implants
  • One set of prescription eyeglasses or one set of contact lenses after the surgery

Medicare covers cataract surgery that involves intraocular lens implants, which are small clear disks that help your eyes focus. Although Medicare covers basic lens implants, it does not cover more advanced implants. If your provider recommends more advanced lens implants, you may have to pay some or all of the cost. It is important to talk with your health care provider before the surgery to understand which costs you will be responsible for, and which costs will be paid by Original Medicare or your Medicare Advantage Plan.

After the surgery, Medicare will also cover one pair of glasses or contact lenses. This is an exception to Medicare coverage rules, which normally exclude eyeglasses from coverage. If you have Original Medicare. you should get your glasses or contact lenses from a supplier that accepts assignment in order to pay the least for your item. You will pay 20% of the Medicare-approved amount for the glasses or contact lenses. If you have a Medicare Advantage Plan, contact a plan representative to learn where you should get your glasses or contact lenses.

Some beneficiaries may have trouble getting Original Medicare or their Medicare Advantage Plan to cover their glasses or contact lenses following cataract surgery. If your glasses or contact lenses are denied coverage, you can appeal the decision. You can request that the glasses or contact lenses be covered, or request reimbursement if you already paid out of pocket for your prescription. You and your health care provider can both write appeal letters to the plan. Be sure to state that because you met the Medicare requirements for cataract surgery, your prescription glasses or contact lenses must be covered.

– Marci

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