Medicare and Cataracts

Taking the Fear Out of Removing Cataracts

Cataracts are the leading cause of blindness in the world. The most obvious symptom of cataracts is clouded vision. In fact, "cataracts" means "waterfall" because, with cataracts, it appears you are looking through a sheet of water. Being diagnosed with cataracts is no cause for alarm. That's because cataracts are a normal part of the aging process. Cataracts are common among people over age 60, including Medicare recipients. Luckily, Medicare covers surgery to correct cataracts as well as glasses or lenses if they are necessary post surgery.

You may have multiple cataracts. The three types of cataracts are nuclear cataracts, cortical cataracts and posterior subcapsular cataracts, which are located on different parts of the eye. If you have multiple cataracts, you will have the cataracts removed from one eye at a time. Cataracts in your other eye may be removed at a different time.

Cataracts are treated by removing the natural lens of the eye that has the cataracts, and replacing it with an artificial lens. Surgery to fix cataracts can be performed on an outpatient basis. Only opthalmologists can perform surgery to correct cataracts.

Surgery is not the only way to treat cataracts. Talk to your doctor about other treatments for cataracts that Medicare covers.

Paying for Surgery to Correct Cataracts with Medicare

If you suspect you have cataracts, you should get an eye exam. If you have cataracts, Medicare will cover the exam. If you do not have cataracts, Medicare will not pay for the exam.

Medicare Part B covers the fees for the surgeon, the facility, the anesthesia and the surgery both to remove the damaged natural lens with the cataracts and to replace it with an artificial lens. You'll pay the normal Medicare Part B cost sharing, which may include your Medicare deductible, and/or 20% of the amount approved by Medicare. And, Medicare pays for any follow-up care after your cataracts are removed, subject to the Medicare coinsurance and Medicare deductible.

If your surgeon does not accept Medicare assignments, you may also pay any amount that the surgeon charges for the surgery to correct cataracts over the amount approved by Medicare. Ask your doctor to refer you to a surgeon that accepts Medicare assignments to avoid extra costs from your surgery to correct cataracts.

Original Medicare also pays for lenses and frames for one pair of glasses or contacts that your doctor prescribes after your cataracts are removed. You must get these glasses or contacts through a supplier who is enrolled in Medicare and who has a Medicare supplier number. Medicare will cover the cost of lenses for both eyes (subject to deductible and coinsurance) even if the cataracts were only removed in one eye. However, Medicare only pays for standard frames. Ask your eye doctor for Medicare eligible frames to avoid extra costs.

You may want to have surgery to correct eye problems that are not related to cataracts during your surgery to correct cataracts. Medicare does not cover any additional costs of the surgery that is not related to the cataracts.

Generally, Medicare does not cover vision correction eyeglasses, contacts or LASIK surgery for reasons unrelated to cataracts. Medicare also does not cover eyeglass "extras" like bifocals, tinted lenses, scratch resistant coating or any contact lens accessories.

You can call Medicare at 1-800-MEDICARE for more information about how Medicare covers surgery to correct cataracts.

Medicare has neither reviewed nor endorsed this information.