Yes, cataract surgery is generally considered a medically necessary surgical procedure and is generally covered by Medicare.
For your cataract surgery to be considered “medically necessary,” your visual acuity will have to be significantly affected. Your surgeon can discuss this with you in greater detail during your complete eye exam.
If you choose premium products and services for your cataract surgery, such as laser cataract surgery or a premium intraocular lens (IOL) for presbyopia treatment, you may have significant out-of-pocket expenses that Medicare will not cover.
Medicare covers basic cataract surgery and IOLs, but not the additional cost of certain IOLs or premium procedures.
During your preoperative exam and consultation, your cataract surgeon will discuss with you the different options available and the associated costs that are not covered by Medicare.
Often, choosing a high-quality IOL or an additional procedure such as limbal relaxation incisions (LRI) to correct astigmatism can significantly improve your vision satisfaction after surgery and is worth the additional expense.
Many surgeons offer financing plans to make payment for products and services not covered by Medicare more affordable. In addition, your surgeon’s business staff can help you understand exactly what Medicare will cover and what Medicare will not cover and any complementary insurance plan you have.
In addition, Medicare Part B (medical insurance) helps pay only one pair of glasses or a set of contact lenses after cataract surgery with an IOL implant. Medicare will pay for glasses or contact lenses only when provided by a provider enrolled in Medicare, regardless of who files the claim (you or your eye doctor or optician).
Remember: Before your cataract procedure, talk to your ophthalmologist and make sure you understand what services and products Medicare will cover and what your responsibility is.