My plan covered my cataract surgery but not the lenses I actually needed-how do they get away with that?
Answered by 30 licensed agents
Answered by Melonie Wood on April 12, 2025
Agent Licensed in FL & AL
Answered by Lt Col Tim Brown on May 14, 2025
Broker Licensed in TN, AL, CO & 10 other states
Answered by Bill Wheeler on August 30, 2025
Broker Licensed in KY & IN
Answered by Misty Bolt on July 5, 2025
Agent Licensed in TN, AL, AR & 45 other states
Answered by David Bell on May 26, 2025
Agent Licensed in ID, AZ, CA & 8 other states
Answered by Jay Larshus on June 30, 2025
Agent Licensed in TN & VA
Answered by Mitch Anderson on May 6, 2025
Agent Licensed in MN, IA & WI
Answered by Justin Doherty on July 10, 2025
Broker Licensed in PA, CO, CT & 10 other states
Answered by Joseph Mullen on July 21, 2025
Broker Licensed in NY, CT, FL & 5 other states
Answered by Steven Bleicher on April 12, 2025
Broker Licensed in AZ
Answered by Diana Garner on June 13, 2025
Broker Licensed in KY, FL, IN, OH & TN
Answered by Steven Lovell on May 24, 2025
Broker Licensed in GA, CA, FL & 7 other states
Answered by Yasmery Vargas on May 15, 2025
Agent Licensed in PA
Answered by Mary Salmon on April 9, 2025
Broker Licensed in TX & OK
While this is frustrating, there are options to assist with coverage. One may choose to enroll in an advantage plan that offers additional coverage for vision. Also, a supplemental vision plan may help mitigate the additional cost for lenses, frames, or contacts.
Answered by Tammy Stoner on May 14, 2025
Broker Licensed in UT, AK, AZ & 7 other states
Answered by Michael Crocker on March 29, 2025
Broker Licensed in SC
Is the plan though you employer or ex employer?
Was state do you resident in?
Answered by Linda Stemerman on August 21, 2025
Broker Licensed in AZ, CO, IA & 7 other states
Elaboration:
Insurance Coverage:
Most health insurance plans (including Medicare) cover the cost of cataract surgery and the standard monofocal IOL, which helps correct vision for one distance.
Premium Lens Options:
However, many insurance plans consider premium or advanced technology lenses, like toric lenses and multifocal lenses, as upgrades and don't fully cover their cost.
Out-of-Pocket Costs:
If you choose a premium lens, you'll likely need to pay the difference between the covered cost of the standard lens and the price of the advanced lens out-of-pocket.
Why the Difference?
The insurance industry often differentiates between the basic medical need of cataract surgery (which they cover) and the patient's choice of a specific lens technology (which may not be covered).
Communicating with Your Insurance Provider:
It's essential to contact your insurance provider before your surgery to fully understand your plan's coverage for different lens options and potential out-of-pocket costs.
Alternatives to Out-of-Pocket Costs:
Some plans might offer options like Medicare Advantage plans, which can provide additional coverage for premium lenses. You can also explore payment plans or financing options offered by eye clinics or surgeons.
Answered by Fred Manas on May 12, 2025
Agent Licensed in NY, CT, DC & 7 other states
did you require special lenses that are not covered by Medicare due to your eyesight issues?
Do you have a Medicare advantage plan? Original Medicare or original Medicare plus a supplement
If it's an advantage plan, you're subject to restrictions that might apply to your insurance company
Normally Medicare and Medicare plus a supplement will cover cataracts and lenses. However, specialty lenses may not be covered
Answered by Gary Henderson on August 11, 2025
Agent Licensed in TX, AK, AL & 46 other states
Standard lenses are covered by Medicare, meaning if you need a basic lens to restore vision, Medicare will usually pay for it.
Answered by Sam Silva on April 10, 2025
Broker Licensed in FL, GA, NJ & 7 other states
Answered by Jack Mayer on August 25, 2025
Agent Licensed in CA & NV
Answered by Charles Borg on April 9, 2025
Agent Licensed in FL & NY
So not sure what you are on....I am guessing a supplement?
Answered by Rachael Metcalf on April 17, 2025
Agent Licensed in TN, FL, GA & 5 other states
Medicare does cover cataract surgery if it's medically necessary, and most plans will cover basic, standard intraocular lenses (IOLs). But if your doctor recommends upgraded or premium lenses—like ones that correct astigmatism or reduce your need for glasses—those are usually considered elective or “not medically necessary.”
That’s how they “get away with it.” The coverage stops at the basic option, and anything beyond that becomes your responsibility—just like choosing frames at the eye doctor beyond the covered pair.
It's not always well explained ahead of time, and that’s part of the problem. I always encourage people to ask up front whether any part of a procedure involves “upgrades” that aren’t fully covered, so there are no surprise bills.
Answered by Angela Wainright on July 25, 2025
Broker Licensed in MN, AZ & ND
Answered by Brian Williams on June 16, 2025
Agent Licensed in FL, AR, CA & 16 other states
Original Medicare (Part B) does cover cataract surgery, including:
✅ Surgery to remove the cataract
✅ A standard intraocular lens (IOL)
✅ One pair of eyeglasses or contact lenses post-surgery
✅ Anesthesia, facility fees, and some follow-up care
❌ What’s not fully covered?
Premium or advanced lenses, like: Toric lenses (for astigmatism) and multifocal or accommodating lenses (for seeing near & far). Anything beyond the basic mono-focal lens
Medicare considers those “elective” or not medically necessary—even if they would improve your quality of life dramatically. So they “get away with it” because they only promise to restore basic vision, not necessarily your best vision.
What can you do?
Appeal – If your doctor documented a medical reason why a premium lens was necessary (not just preferred), you might have a case. (I have never seen anyone win an appeal) Pay with a pre-Medicare FSA or HSA may be able to used toward the cost.
Answered by Tracy Brown on April 13, 2025
Broker Licensed in CA, AL, AR & 32 other states
Answered by Alyssa Scripter on June 2, 2025
Agent Licensed in PA, CO, FL & 10 other states
Answered by Andrew Norton on April 24, 2025
Broker Licensed in PA, CA, CT & 9 other states
Answered by Ida Lipnicky-LaCorte on August 23, 2025
Broker Licensed in NJ, FL, NY, PA & SC
Answered by Dan Griggs on August 30, 2025
Agent Licensed in MO
Tags: Coverage
Agents: Share Your Expertise
Have insights or experiences related to this topic? Help others by sharing your knowledge and answering this question.
Seniors: Ask a Question of Your Own
Questions are generally answered within 1 to 3 business days. Receive valuable perspectives from multiple licensed agents and brokers.
Ask a Question