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Health Insurance Basics

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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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are the 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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