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

Melonie Wood · Accepted 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

Gregg Matheny · 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

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

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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