Is Medicare's coverage for cataract surgery enough, or do seniors still face high out-of-pocket costs?
Answered by 10 licensed agents
Original Medicare covers 80% of a variety of services including cataract surgery. Depending on how you subsidize original medicare your costs will vary. Medicare is a very individual choice and one to not take lightly. My job is to educate you on your choices to supplement and ensure you understand the pros and cons of each.
If a person has a Supplement/Medigap (Plan G, F, or N) cataracts would be covered 80% by Part B and then the 20% would be covered by Plan G/F/N after the $257 Part B Medical deductible has been satisfied. That's excellent coverage. If a beneficiary has Advantage (HMO or PPO) cataract surgery is typically covered under the outpatient procedure benefit, which can vary by plan and by state. I've seen outpatient surgery as low as around $100 and it can be as high as $400 or more. That's why people need independent agents like myself to navigate these differences in plans and coverage.
After meeting the $257 Part B deductible, you will have the 20% responsibility. Now if you have a Supplement plan to your Original Medicare, then the 20% should be paid in Full, or at least in part, of the remaining balance.
Original Medicare most times will cover cataract surgery if the cataract is affecting your vision or daily activities. If the surgery is approved, Medicare will cover removal of the cataract, implantation of a standard intraocular lens (IOL), and hospital stay if necessary. When considering Medicare plans, it is much cheaper to have a Medicare Advantage or Supplement Plan when it comes to in/out patient procedures, hospital stays, and doctor copays. With a Medicare Advantage you will have set copays for all doctor visits, er/hospital stays, out/in patient procedures, and added supplemental benefits not offered by Original Medicare like Dental, Vision, and Hearing. The out of Pocket Costs for a cataract surgery with just Original Medicare would be:
Coinsurance: Typically 20% of the Medicare-approved cost
Deductible: The annual deductible for Part B is currently $257 (2025)
Upgraded IOLs: Medicare does not cover the cost of more advanced or specialized IOLs
Medicare covers cataract surgery like most other types of medically necessary procedures. It does not matter if you're on Original Medicare with a Supplement or a Medicare Advantage plans...they cover it the same, in terms of the procedure. IF you wanted to do the Lasik surgery while they are fixing the cataracts, it would be an additional charge, since Lasik is not considered medically necessary
Medicare Part B covers 80% of the cost of cataract surgery and post-surgical corrective lenses. You must first meet the annual deductible, which is $257 in 2025, and pay 20% of the cost of cataract surgery. A Medigap plan will cover the remaining 20% cost you are responsible for paying.
It depends on what coverage that you have. Traditional medicare and a supplement you would pay out of pocket max $240.00 in 2025 if you had not met the deductible for part B. Depending on the lenses you choose to replace it ranges from $0 to $4,000 in 2025. Should you need glasses after the removal of the cataract medicare covers the first pair. Mind you, they are basic not designer frames.
With a medicare advantage plan, it depends on your outpatient copays
