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Cataract surgery is expensive if you pay for it out of pocket, but you have options if you can’t afford it.
Since most cataracts occur in older adults, Medicare often covers it. Around one out of every five adults over the age of 65 in the United States has a cataract.
Cataract surgery is deemed a medically necessary procedure. As a result, medical insurance can often help to cover the costs of the surgery.
Other organizations, like Operation Sight, may be able to help if you are unable to afford cataract surgery.
Medicare Coverage for Cataract Surgery
Medicare is the federal health care program that provides insurance coverage for Americans ages 65 and older. While Medicare does not cover routine vision screening or prescription eyeglasses or contact lenses, it will provide coverage for cataract surgery.
Medicare coverage stipulates that the surgery must be done with lasers or traditional surgical techniques using a traditional intraocular lens (IOL) implant. Typically, Medicare will cover about 80 percent of the procedure, and you will be responsible for covering the rest out of pocket. This includes copays and the difference in price if you need any specialty lenses.
Medicare Part B or a Medicare Advantage plan can cover various things related to cataract surgery, such as:
- Exams prior to the surgery.
- Surgical removal of the cataract.
- Implantation of a traditional IOL.
- A hospital stay if necessary due to complications (not usually needed).
- Postoperative exams.
- One pair of prescription eyeglasses after surgery.
Check with your specific Medicare plan to find out exactly what is covered, how much, and what your out-of-pocket expenses will be. Supplemental plans like Medigap can help you cover the other 20 percent of the cost.
Using Insurance to Help Pay for Cataract Surgery
You don’t need specialty vision insurance for cataract surgery to be covered. As a surgical procedure, it is often covered the way any surgical or medical procedure would be.
The exact amount of coverage will depend on several factors, such as:
- Your specific plan.
- Where you live. Insurance plans and coverage are often regional or state-based.
- Your deductible. This is the amount you will need to pay out of pocket each year before coverage kicks in.
- Type of coverage. Depending on the specifics of your coverage, the amount you will need to pay can vary based on copays, in-network and out-of-network providers, and the type of surgery desired or needed.
Insurance coverage can range greatly based on the provider and your plan. Discuss any medical and surgical procedures with your provider before taking any kind of action. They will help you determine exactly what your cost is going to be and what is going to be covered.
Most insurance will cover the basics for cataract surgery, but if you have a high degree of refractive error or astigmatism, you may require a specialty lens or a more complicated procedure that is not covered the same way. The overall cost will be affected by the type of surgery, replacement lens, and individual surgeon fees.
Talk to your health care provider to iron out all of the fees and costs associated with cataract surgery ahead of time. Ask all your questions in advance, so there aren’t any financial surprises later.
Additional Options for Help With Cataract Surgery
Medicare is a federal public assistance program that can help you pay for cataract surgery. Medicare offers free or low-cost health care coverage to American adults ages 65 and older.
Resources like Prevent Blindness offer information on services that can give you direction if you can’t afford cataract surgery. Your local Lion’s Club may offer financial help for vision care, which can include assistance for cataract surgery.
The National Eye Institute (NEI) also offers information on foundations and organizations that offer free cataract surgery or services for people with low incomes, including Mission Cataract USA and Operation Sight.
Talk to your health care provider about options to help you pay for cataract surgery when cost is a barrier. There are many options and resources at your disposal, so you don’t have to suffer from the effects of cataracts.
Cataracts. (2020). AGS Health in Aging Foundation.
Eyeglasses & Contact Lenses. Medicare.gov.
Does Medicare Cover Cataract Surgery? (September 2020). Medical News Today.
What’s Medicare Supplement Insurance (Medigap)? Medicare.gov.
Your Sight Vision Care Financial Assistance Information. Prevent Blindness.
Get Help Paying for Eye Care. (October 2020). National Eye Institute (NEI).
FAQ. (2014). Mission Cataract USA.
Foundation Operation Sight. (2020). ASCRS.