My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?

Question

Larry Dalton · Accepted Answer

Medicare does cover cataract surgery, and I have personally undergone the procedure. However, they only cover standard lenses, and you will need to pay extra if you want to purchase a premium lens or any other special types. These are considered luxury items or cosmetic options by Medicare and are not deemed absolutely necessary. Nonetheless, Medicare does cover the cost of the surgery as well as the standard lenses.

Answered by Larry Dalton on April 7, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Tasha Riggs · Answer

Medicare will cover Cataracts.  The more expensive upgraded Crystal lenses are and "option" not medically needed but nice to have or get if you can afford it. 
Medicare will cover the regular lenses.

Nikki Rowland · Answer

Medicare will cover the basic lens.  If you want to upgrade, you will pay out of pocket for the upgraded lens. This is normal.

Michael Caldwell · Answer

Medicare covers cataract surgery that uses standard intraocular lenses (IOLs) and the procedure itself, but it doesn't always cover the cost of more advanced or customized lenses like multifocal or toric lenses. Your friend's preferred lens might have fallen into this category, requiring her to pay the additional cost out of pocket. 
Here's a breakdown:
Medicare Part B Coverage:
.
Medicare Part B generally covers the cost of cataract surgery, including the removal of the cloudy lens and the implantation of a standard IOL. 
Standard vs. Advanced Lenses:
.
Medicare typically covers standard, single-focus IOLs. Advanced lenses, like multifocal or toric lenses, are often not covered, requiring patients to pay the difference. 
Out-of-Pocket Costs:
.
If your friend's preferred lens was not a standard IOL, she likely would have had to pay the difference between the cost of the standard lens covered by Medicare and the cost of her preferred lens. 
Medicare and
Glasses:
.
Medicare Part B does cover one pair of glasses with standard frames (or one set of contact lenses) after cataract surgery. However, Medicare doesn't usually cover the cost of glasses or contact lenses unless it's related to cataract surgery with an IOL. 
Medicare Advantage:
.
Medicare Advantage plans must cover the same services as Original Medicare, but they may have different rules for vision care. If your friend has a Medicare Advantage plan, she should check with her plan for specific information on coverage for glasses and lenses after cataract surgery.

Steven Bleicher · Answer

Since there is NOW a special kind of (all-in-one) lens that can take into account both nearsightedness & farsightedness (a.k.a., like a regular progressive lens) in one set of lenses, that option is NOT a part of Original Medicare. In this case, the ophthalmologist was wrong in not telling her that this is not covered by Medicare since she/he should know this. Your friend can, if she wishes, file a Medicare grievance against that doctor but it likely won't do YOU any good but should help other folks in the future.

Answered by Steven Bleicher on April 22, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Deb Haley · Answer

Most Medicare plans cover cataract surgery, however the lens you can choose must be either for distance or near. If you choose to have the upgraded lens that covers both you will have an additional charge. If you use a standard lens and need new prescription eyewear after the surgery there typically is no cost for the eyewear.

Answered by Deb Haley on May 9, 2025

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

Answered by Deb Haley Medicare Insurance Agent

Maurice Ellis · Answer

A (MAP) Medicare Advantage Plan that covers hearing, vision and dental could have help with the expenses.

Fred Manas · Answer

Medicare generally covers the cost of cataract surgery, including the insertion of a standard intraocular lens (IOL), but not advanced or premium lenses that offer more specific vision correction. The "standard" lens covers the basic needs of focusing light on the retina. If a patient desires a lens with features like reduced need for glasses, additional cost is usually the patient's responsibility.

Answered by Fred Manas on April 21, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Gary Henderson · Answer

Medicare covers medically necessary cataract surgery, including the implantation of a standard monofocal intraocular lens (IOL), but typically does not cover more advanced lens options like toric or multifocal lenses. 
You would have out-of-pocket cost for those

Deborah Webster · Answer

Traditional Medicare does not cover eyewear. I cannot really answer this question in detail because I do not have enough information about what plan she was enrolled in. I would need more details about the circumstances in this situation.

Answered by Deborah Webster on April 10, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Rachael Metcalf · Answer

So depending on what plan you choose, will be the way the lenses are covered. Many plans have a $0 copay or an amount like $30 copay.

Betty McCarty · Answer

Medicare does cover medically necessary cataract surgery, including the standard monofocal intraocular lens (IOL) used to replace the eye’s natural lens. 

However, it typically does not cover the cost of advanced or premium IOLs, such as toric or multifocal lenses, which are designed to correct astigmatism or enhance vision beyond what standard lenses provide.

Hopefully this answers your question! If you have further questions regarding Medicare coverage, feel free to contact your local Medicare agent.

You can also email us at bkconnections@comcast.net and we will be happy to assist you.

My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?

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My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?

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