2025 Medicare Cataract Surgery Costs: What You Need to Know About Coverage and Out-of-Pocket Fees

Cataract surgery is a widely performed eye procedure, and Medicare provides substantial coverage for it. However, patients should be aware that some out-of-pocket expenses such as deductibles and copayments may still apply depending on the specifics of their Medicare plan and surgery location.

More than half of Americans aged 80 and older have cataracts or have undergone cataract surgery, making it one of the most common eye treatments covered by Medicare. Although routine vision screenings are not covered, Medicare does cover the surgery itself.

Out-of-pocket costs vary based on your Medicare plan, surgery type, and facility. Additional charges may include hospital or clinic fees, deductibles, and copays.

Understanding Cataract Surgery Costs in 2024

Medicare covers two main types of cataract surgery at equal rates:

• Phacoemulsification: Uses ultrasound to break up and remove the cloudy lens, replacing it with an intraocular lens (IOL).
• Extracapsular surgery: Removes the cloudy lens in one piece and implants an IOL.

Your ophthalmologist will recommend the best procedure based on your condition.

Before Medicare coverage, the average cost of cataract surgery ranges from approximately $1,906 to $2,943, varying by location and facility type.

How Much Will Medicare Cover for Cataract Surgery?

The final cost depends on several factors, including:

• Your specific Medicare plan
• The type of cataract surgery performed
• Surgery duration
• Facility setting (clinic vs. hospital)
• Additional health conditions and possible complications

Estimated Medicare Cataract Surgery Costs:

• At a surgical center or clinic: Average total cost is $1,906. Medicare typically covers $1,525, leaving an estimated $380 for you.
• At a hospital outpatient department: Average total cost is $2,943. Medicare pays $2,355, with about $588 out-of-pocket.

These figures include both doctor and facility fees and may vary by location.

Which Medicare Parts Cover Cataract Surgery?

Medicare coverage for cataract surgery includes:

• Removal of the cataract
• Implantation of an intraocular lens
• One pair of prescription eyeglasses or contact lenses following surgery

Medicare Part A covers inpatient hospital stays, which is rare for cataract surgery but applicable if hospitalization occurs.

Medicare Part B covers outpatient procedures, including cataract surgery and related doctor visits before and after the procedure.

Medicare Part C (Advantage Plans) offers similar coverage to Parts A and B but through private insurers, which may have different costs and benefits.

Medicare Part D covers prescription drugs you may need after surgery, though some medications might require out-of-pocket payment if not on the approved list.

Medigap (Supplement Plans) can help cover deductibles and copayments not paid by Original Medicare.

How to Estimate Your Cataract Surgery Costs Beforehand

Consult your eye doctor and Medicare provider to get a clear picture of your potential expenses. Key questions include:

• Does your doctor accept Medicare?
• Will the surgery be at a surgical center or hospital?
• Will you be treated as an inpatient or outpatient?
• What prescriptions will be necessary before and after surgery?
• What is the Medicare procedure code for your surgery? (Use this to check costs on Medicare’s pricing tools.)

Your healthcare provider can often estimate the percentage Medicare will cover and your expected out-of-pocket costs.

If you have a Medicare Advantage or private insurance plan, contact your provider for detailed cost information.

Additional Factors Influencing Your Costs

Your out-of-pocket expenses may also depend on:

• Your Medicare plan details
• Deductibles and out-of-pocket maximums
• Other health insurance coverage
• Eligibility for Medicaid
• Coverage of medications under Medicare Part D
• Complexity of your medical condition

Veterans may find more affordable cataract surgery options through VA benefits.

About Cataracts and Surgery

Cataracts occur when the eye’s natural lens becomes cloudy, causing symptoms such as:

• Blurred or dim vision
• Yellowing or fading of colors
• Difficulty seeing at night
• Halos around lights
• Double vision
• Increased sensitivity to glare

Cataract surgery replaces the clouded lens with a clear artificial lens, typically performed as an outpatient procedure by an ophthalmologist.

Frequently Asked Questions

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Final Thoughts

Cataract surgery remains a common and generally affordable procedure thanks to Medicare coverage, but patients should prepare for potential additional costs. Understanding your Medicare plan and discussing details with your healthcare providers can help you manage expenses effectively.

For Spanish readers, this article is also available in Spanish.

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