I've got a Medicare Advantage plan, and I'm curious if my upcoming eye surgery is fully covered or if I'll owe extra out of pocket.

Question

Gregg Matheny · Accepted Answer

That would be a great question to ask the provider prior to the surgery. A good ophthalmologist office Is usually very aware of the codes that they will bill to Your Medicare advantage plan And they may Tell you your cost. You should also be able to contact your Medicare advantage plans member services number and they can answer that question for you. If it is a cataract surgery, that’s a little different. Medicare fully covers cataract surgery with a standard lens. If you are using any type of upgraded lens, then Medicare will not pay for the upgraded lens And you will be financially responsible for that cost.

Answered by Gregg Matheny on March 26, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Lt Col Tim Brown · Answer

If it’s an out patient surgery, you have your out patient surgery co pay. If it is as an in patient, then you would have that co pay.  Check your materials for your evedence of coverage.

Andrew Zurbuch, MBA · Answer

Please see your Evidence Of Coverage document on your Medicare Advantage plan.  
Thank you.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Melonie Wood · Answer

Your Medicare Advantage will cover cataract surgery, most Medicare Advantage plans will have an outpatient co pay for the facility, and a co pay for your surgeon. You will need to talk to your agent OR the carrier to find out yur co pays, what your plan will pay & additional benefits

Answered by Melonie Wood on April 8, 2025

Agent Licensed in FL & AL

Answered by Melonie Wood Medicare Insurance Agent

Clarence &quot;Mark&quot; Christiansen · Answer

This depends on the nature of the procedure. Medically necessary cataract surgeries are for the most part covered by all Medicare Advantage plans and you will typically pay your plan's outpatient surgery amount or copay. If you need cataract surgery on both eyes, expect to pay an additional copay for the second eye. There is a very nice, "enhanced," multifocal procedure which is not an approved benefit by Medicare and this is likely not covered by any Advantage plan. Expect to pay $ 5,000 per eye for the privilege of not needing reading glasses! If your upcoming eye surgery is other-than-cataract, ask you doctor to secure a Prior Authorization from your plan before going ahead with the work.

Answered by Clarence "Mark" Christiansen on April 3, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Christy Jones · Answer

Your eye surgery should be covered under your Medicare Advantage plan. You will owe a copay for outpatient surgery at an 'Ambulatory Surgical Center'. This copay can be less than an outpatient surgery copay performed at the hospital. Check your Summary of Benefits to see what your copay will be. You can also call your insurance company (or Broker) to see what your copay would be.

Answered by Christy Jones on August 1, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Steven Graves · Answer

Thank you for reaching out to us. To get detailed information about your coverage, please contact the phone number listed on the back of your Medicare Advantage card. A representative will be able to access your policy and review your benefits with you.

We apologize that we couldn’t assist you further.

Robert Pennington · Answer

If this is done Hospital, inpatient, or outpatient, or ambulatory surgical center, there will be a copay. The copay will be less if in-network rather than out-of-network. The copay would be subtracted from your plan's max out-of-pocket.

Answered by Robert Pennington on May 21, 2025

Broker Licensed in NC, GA, SC & VA

Answered by Robert Pennington Medicare Insurance Agent

David Silver · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/ive-got-a-medicare-advantage-plan-and-im-curious-if-my-upcoming-eye-surgery-is-fully-covered-or-if-ill-owe-extra-out-of-pocket#david-silver

Ray McCauley · Answer

No its not fully covered. Depending on your plan you may have a deductible and will definitly have some type of co-pay.

Jennifer McDonnell · Answer

Normally your eye surgery will be done on an 'outpatient' basis.  This means your MAPD plan most likely will have an outpatient 'copay' however you should also gave the doctor do a pre-determination with the insurance company to make sure the surgery will be allowed.
Medicare Advantage plans sometimes may disagree with the doctors recommended treatment.

Eli Roque · Answer

On Medicare Advantage plan you will have copayments for services rendered. You will have to look at your summary of benefits or call customer service of the Medicare Advantage plan you have!!

Melissa Foster · Answer

Yes, there will likely be some out of pocket costs. All plans are different, with different co-pays and deductibles so this is a generic non specific answer.

Steven Bleicher · Answer

Bear in mind that there are over 60,000 treatments that are covered by a government subsidized Medicare Advantage plan, being your Primary insurance at 80%. The rest of the money or 20% is paid by Medicare itself, your Secondary insurance. However, some things written in the policy may not be completely covered. Your doctor should know that! This is the “give and take” since you’re responsible for a somewhat steep deductible since you likely have no monthly premium.

Answered by Steven Bleicher on March 30, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Timothy Brown · Answer

No Medicare Advantage plan covers surgery fully or 100 percent. You will have a copay for the surgery whether it’s inpatient or outpatient. I would call member services on the back of your insurance card to get an idea of what it will cost.

Answered by Timothy Brown on May 3, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Dana Dane · Answer

Please contact your Medicare Advantage plan agent.  If you do not have one, please contact your insurance company.

Leslie Kaz · Answer

Your surgery should be covered if it's medically necessary and done in-network. But you’ll still likely pay the Part B deductible, 20% coinsurance, and possible additional fees based on plan structures and any upgrades you choose.

Before You Go Under
Ask your eye surgeon whether they accept Medicare and your Advantage plan.

Confirm if the surgery is medically necessary or elective.

Request a cost estimate by billing code and facility type (clinic vs. hospital).

Call your Medicare Advantage plan to check:

Annual deductible status

What coinsurance or copays apply

Whether your provider and facility are in-network

What vision benefits (if any) are included

Deb Haley · Answer

Most medicare advantage plans cover cataract surgery. There is typically a copay for the "day surgery". The copay amount may differ if the surgery is performed at an ambulatory surgical center versus at the hospital. You will want to check with your plan carrier prior to the surgery to get estimated copays and confirm that the facility and doctor doing the surgery are 'in network' for your plan, as out of network may be covered at higher co-insurance amounts.

Answered by Deb Haley on July 3, 2025

Broker Licensed in MA, CT, FL & 10 other states

Answered by Deb Haley Medicare Insurance Agent

Janet Cruz · Answer

Medicare advantage plans cover medically necessary eye surgeries, such as glaucoma or cataracts procedures. 

Each Medicare advantage plan has its own cost sharing structure. You’ll need to review your plan’s summary of benefits. 

Furthermore you may be responsible for out of pocket costs depending on the plan you have.

Andrew Kramer · Answer

I assume you mean cataract surgery? Medicare covers the basic lens, which corrects for distance. But that lens does not correct for astigmatism. An upgraded lens that does correct for astigmatism is rather expensive, about $2,500 to $3,000. I suggest you speak with your optometrist and ask if your level of astigmatism (cylinder) would require you to wear glasses after the cataract surgery, if you get the basic lens. If you just get the basic lens, your total co-pay for the surgery would be your co-pay on your plan for out-patient surgery, assuming they don't use a laser, but rather the micro-slit.

Answered by Andrew Kramer on May 19, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Todd Bostic · Answer

I can’t guarantee it, but more than likely, most Medicare Advantage will not cover 100% of eye surgery you will probably have a copay to go with it.

Karen Ansell · Answer

You will normally have a  copay or coinsurance for eye surgery. Please look at you evidence of coverage book to determine this.

Jerry Cohen · Answer

This question omits information like whether the surgery is being performed by an in network or out of network physician but in either case, there will be an out of pocket amount to the patient in the form of deductibles; co insurance; and Co Pays.

Answered by Jerry Cohen on May 7, 2025

Broker Licensed in NY

Answered by Jerry Cohen Medicare Insurance Agent

Ronnie Robinson · Answer

Depends on your Medicare Advantage Plan. Most have a copay and possibly a deductible that must be paid prior to the surgery.

Kris Neupauer · Answer

Well what is the surgery? That is the only way we can properly assess coverage. If the surgery is medically necessary (like cataract or glaucoma surgery), it’s likely to be covered, but there could still be out-of-pocket costs like co-pays, deductibles, or coinsurance. If the surgery is elective (like LASIK), it probably won’t be covered by your Medicare Advantage plan. Make sure to check with both your Medicare Advantage provider and the surgical center to understand exactly what will be covered and any potential out-of-pocket expenses.

Answered by Kris Neupauer on May 1, 2025

Broker Licensed in MN, ND, SD & WI

Answered by Kris Neupauer Medicare Insurance Agent

Sophia Davis · Answer

typically, with a Medicare Advantage plan, there is a set copay for surgical procedures. To find out what that is for your specific plan please contact your agent, your carrier, the Evidence of Coverage document (if you have it), or your Member Portal (if you are tech savvy). If you have any further questions I'm happy to help you locate this information.

Answered by Sophia Davis on July 19, 2025

Broker Licensed in OH & PA

Answered by Sophia Davis Medicare Insurance Agent

Lesley Burns · Answer

Until your plan is reviewed by a licensed Medicare agent, we can not provide an accurate overview of what your plan will pay for. A licensed Medicare agent can review your plan and provide an update on whether your eye surgery is fully covered or not.

Answered by Lesley Burns on May 6, 2025

Broker Licensed in AR, MI, MO, NM & TX

Answered by Lesley Burns Medicare Insurance Agent

Susan Winters · Answer

Medicare Advantage plans are required to cover everything Original Medicare (Parts A & B) covers—this includes outpatient eye surgeries when deemed medically necessary by your doctor. You’ll be responsible for cost-sharing—coinsurance, copays, and deductibles. It is best to check you evidence of coverage with your carrier

Answered by Susan Winters on July 16, 2025

Agent Licensed in FL, AL, AR & 16 other states

Answered by Susan Winters Medicare Insurance Agent

Alyson Collins · Answer

Your Medicare Advantage plan will usually cover eye surgery if it’s medically necessary, but you may still owe a copay or coinsurance based on your plan’s rules. Coverage depends on whether your surgeon and facility are in-network and if prior authorization is approved. To know your exact costs, contact your plan’s member services with your procedure details for a breakdown.

Answered by Alyson Collins on August 13, 2025

Agent Licensed in TX, AR, LA & NM

Answered by Alyson Collins Medicare Insurance Agent

I've got a Medicare Advantage plan, and I'm curious if my upcoming eye surgery is fully covered or if I'll owe extra out of pocket.

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I've got a Medicare Advantage plan, and I'm curious if my upcoming eye surgery is fully covered or if I'll owe extra out of pocket.

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