Cataract surgery remains one of the most frequently performed medical procedures worldwide. In the United States alone, over 3.5 million people undergo this surgery annually, according to the American Society of Cataract and Refractive Surgery. It is also remarkably successful, with approximately 90% of patients experiencing significant improvements in vision post-surgery. Given its prevalence and effectiveness, many patients wonder whether Medicare will help cover the costs of cataract removal and lens implantation. Understanding what Medicare covers can be complex, but this guide aims to clarify your options and ensure you receive the necessary care without unexpected expenses.
What Is Cataract Surgery?
Cataract surgery involves removing the cloudy lens inside the eye caused by aging and replacing it with a clear, artificial lens known as an intraocular lens (IOL). This outpatient procedure is quick, minimally invasive, and generally painless thanks to advancements in ophthalmic technology. During the operation, the surgeon makes a small incision to access the cataract, which is then carefully broken up and extracted. Afterward, the new IOL is implanted to restore clear vision.
Cataracts develop as protein structures within the eye’s lens begin to break down over time. As these proteins accumulate, they cause the lens to become opaque, leading to blurred or cloudy vision and, if untreated, potential blindness. Surgery remains the only definitive treatment, and many patients opt for premium lenses that can reduce the need for glasses after surgery. However, these advanced lenses are usually not covered by Medicare, so it’s important to understand your coverage options.
Postoperative recovery is typically short, with patients advised to follow specific aftercare instructions and attend follow-up appointments to monitor healing and prevent complications. If you’re considering surgery, consulting with a qualified cataract specialist can help you understand your options and prepare accordingly.
Does Medicare Cover Cataract Surgery?
Coverage for cataract surgery under Medicare depends on specific medical criteria and where the procedure is performed. Generally, Medicare considers cataract removal to be medically necessary if the condition interferes with daily activities or quality of life, which is verified by your healthcare provider. This means that if your doctor deems the surgery essential, Medicare is likely to provide coverage.
Medicare Part B typically covers outpatient procedures, including cataract removal, but there are important details to consider. For example, in hospital outpatient settings or ambulatory surgical centers, once you meet the annual deductible (which was $257 in 2025), you are responsible for paying 20% of the Medicare-approved amount for both the procedure and the lens implant. Similarly, if the surgery is done in a doctor’s office, the same cost-sharing applies after meeting the deductible.
In addition to covering the procedure itself, Medicare Part B also pays for a basic pair of glasses or contact lenses after surgery, but it does not usually cover premium intraocular lenses or elective procedures aimed at correcting other visual issues like nearsightedness. To help offset out-of-pocket costs, some Medicare supplement plans may offer coverage for premium lenses or additional services.
What Is Medicare Part A?
Medicare Part A provides inpatient hospital coverage, including care received during hospital stays, critical access hospital stays, or skilled nursing facilities. It occasionally covers hospice and certain home health services but generally does not apply to outpatient surgeries such as cataract removal.
Does Medicare Part B Cover Cataract Surgery?
Yes, Medicare Part B covers cataract surgery when it is deemed medically necessary and performed in an outpatient setting. This part of Medicare also covers diagnostic tests, preoperative assessments, and postoperative care related to the procedure. It’s essential to verify your specific plan details, as coverage can vary based on your geographic location and the healthcare provider.
What Is Medicare Advantage (Part C)?
Medicare Advantage plans, offered by private insurers, combine coverage from Part A and Part B and often include additional benefits like prescription drug coverage (Part D). These plans may offer different coverage options, costs, and provider networks compared to Original Medicare. Some plans may cover services not included in standard Medicare, but it’s crucial to review the plan details and confirm coverage for cataract surgery before scheduling your procedure.
Does United Healthcare Cover Cataract Surgery?
United Healthcare generally provides coverage for cataract surgery through their Medicare Advantage plans. However, coverage specifics, including copays, deductibles, and prior authorization requirements, vary between plans. It is highly recommended to contact United Healthcare directly to verify your coverage and understand your financial responsibilities. Many plans may require prior approval before the procedure, so confirming your coverage in advance can prevent surprises.
Similarly, other providers like Humana also cover cataract surgeries under certain plans. Always check with your insurance provider beforehand to clarify your benefits and ensure the procedure will be covered.
How Much Is Cataract Surgery?
The cost of cataract surgery varies widely depending on location, the type of lens chosen, the complexity of the procedure, and your insurance coverage. Without insurance, the total cost can range from $3,000 to $5,000 per eye or more. When covered by Medicare, your expenses typically include the deductible and a 20% coinsurance, which can significantly reduce your out-of-pocket costs.
Medicare’s coverage often ensures that you pay only a portion of the total bill, but additional costs may arise if you select premium intraocular lenses or opt for elective procedures. To get a clear estimate tailored to your situation, contact your local ophthalmologist or the nearest OCLI Vision office. They can work with your insurance to ensure maximum coverage and provide an accurate cost estimate.
Understanding the future of healthcare technology, including artificial intelligence, is also shaping how treatments like cataract surgery are delivered. For insight into emerging innovations, explore topics such as the role of AI in healthcare, which is transforming patient care.
In conclusion, while Medicare offers substantial coverage for cataract surgery, it’s essential to verify your specific plan details and work with your healthcare provider to ensure you receive the care you need without unexpected expenses. Cataract surgery can restore clear vision and significantly improve quality of life, making it a vital procedure for those affected by the condition. Schedule a consultation with a qualified ophthalmologist today to discuss your options and get an accurate cost estimate.
Back to our blog
Share this blog on social media: