Cataract surgery › Cost and Medicare
What cataract surgery costs, and what Medicare pays
- Covered
- Surgery, facility, standard lensMedicare Part B, once the cataract meets the threshold
- You pay
- Deductible, then 20%unless supplemental coverage picks it up
- Not covered
- Toric, EDOF, multifocal, LALbilled to you, out of pocket
- Laser
- You, if for a refractive upgradefemtosecond laser
Does Medicare pay 100% for cataract surgery? No, and the distinction is the most misunderstood thing about paying for it. Medicare covers the operation and a basic lens. It does not cover the decisions that turn it into a refractive procedure.
Who pays for what
Medicare Part B pays
- The surgery
- The facility
- A standard monofocal lens
- Once the cataract meets the threshold
You pay
- The Part B deductible, then 20% coinsurance, unless supplemental coverage picks it up. Medicare Advantage varies.
- A toric lens for astigmatism
- Extended depth of focus and multifocal lenses
- The Light Adjustable Lens
- The femtosecond laser, when used for a refractive upgrade
Why the upgrades are not covered
Medicare and most insurers cover the operation and a standard monofocal lens once the cataract affects your vision enough to meet their criteria, subject to your deductible and coinsurance. What they do not cover is the refractive upgrade. Toric, extended depth of focus, multifocal and light adjustable lenses are billed to you. A standard monofocal lens is sharp at one distance, usually far, with reading glasses for the rest. Nothing else matches it for optical quality, and it is the lens Medicare covers. The other designs add range without glasses, and that range is what you are paying for.
Get the figure in writing
Practices should give you that figure in writing beforehand, and you should know it before you are asked to choose a lens on a consent form.
The three choices, and what each costs
- 1Clear far away
Monofocal lens. Covered by Medicare and most insurance. You would still wear glasses for reading and small print.
- 2Clear far away and at arm’s length
Extended depth of focus. Paid by you, on top of what insurance covers. Glasses for small print, some of the time.
- 3Clear at most distances
Multifocal or trifocal. Paid by you, on top of what insurance covers. Little or nothing, most days.
Compare the three choices in full, including what each one gives up.
This is one part of the full guide. Cataract surgery and intraocular lens (IOL) selection covers the lens choice, the measurements behind it, the risks with their numbers, and a vision simulator.
Educational information, not medical advice. Discuss your specific eyes with a qualified ophthalmologist.