Does Medicare Cover Cataract Surgery?

An elderly woman with blue eyes.

Does Medicare Cover Cataract Surgery?

As we age, our bodies undergo numerous changes, some of which can negatively impact our quality of life. These challenges can be as simple as getting eyeglasses or contact lenses. Other times, though, the challenge can be a bit more complicated like with developing cataracts. Cataracts are a common eye condition that can lead to blurred vision and other complications. This raises the question: does Medicare cover cataract surgery? There isn’t a short answer to this comment question, so we’ve created this detailed guide to delve into this topic and explore the types of coverage offered by Medicare for cataract surgery, the types of lenses covered, and other related aspects such as astigmatism correction and follow-up care.

Understanding Cataracts

Cataracts develop as the proteins within the eye’s natural lens become cloudy, often leading to blurry or distorted vision. This is a common condition that can occur as a result of aging, eye injury, genetics, long-term steroid use, and other factors. In fact, by the age of 75, one in two individuals is likely to have developed cataracts.

Symptoms of Cataracts

Typically, cataracts present several symptoms, including:

  • Cloudy or blurry vision
  • Sensitivity to light or glare
  • Difficulty seeing at night
  • Halos around lights
  • Need for brighter light for reading
  • Fading or yellowing of colors
  • Frequent changes in eyeglass or contact lens prescription

Cataract Surgery: An Overview

Cataract surgery is one of the most commonly performed surgical procedures in the United States, with approximately 2 million individuals undergoing the procedure annually. The surgery involves the removal of the cloudy lens, which is then replaced with a clear, artificial one. This outpatient procedure is a quick, effective, and generally safe path to clear vision, with overnight hospital stays typically not required.

An elderly man gets an eye exam from his eye doctor.

Is Cataract Surgery Covered by Medicare?

Medicare is a federal health insurance program designed primarily for individuals aged 65 and older. It provides coverage for a range of medical services, including doctor visits, hospital stays, and prescription drugs. When it comes to cataract surgery, the coverage can vary depending on the specific Medicare plan.

Medicare Part B

Medicare Part B provides coverage for medically necessary services used to treat and diagnose health conditions. This includes cataract surgery, which is considered a medically necessary outpatient procedure. Under Part B, Medicare covers not only the cost of the surgery but also that of the intraocular lens (IOL) implanted during the operation.

However, Part B coverage does not extend to any additional fees or upgraded lens options that may eliminate the need for glasses post-surgery. Also, the coverage does not imply that the surgery will be completely free of cost. Beneficiaries may still have to pay the 20% coinsurance amount and the Part B deductible.

Medicare Supplement Insurance (Medigap)

Medigap policies, sold by private insurance companies, are designed to help cover the costs not covered by Original Medicare. These include copayments, coinsurance, and deductibles. Certain Medigap policies may even cover services not approved by Original Medicare, such as medical care during foreign travel. However, they typically do not cover long-term care, vision or dental services, hearing aids, prescription eyeglasses, corrective lenses, or private-duty nursing.

Medicare Advantage (Part C)

Medicare Advantage, or Part C, is an all-in-one alternative to Original Medicare. Sold by private companies, these plans bundle Part A (hospital coverage), Part B (doctor and outpatient services), and sometimes Part D (prescription drug coverage) into one comprehensive plan.

Specific Aspects of Cataract Surgery Coverage

Does Medicare Pay for Cataract Surgery?

Yes, both Original Medicare and Medicare Advantage cover cataract surgery that involves the removal of a cataract and the replacement with a conventional intraocular lens. Original Medicare covers 80% of the cost of cataract surgery, with the patient responsible for paying the remaining 20% (either as out-of-pocket expenses or with supplemental insurance).

What Type of Lens Does Medicare Cover for Cataract Surgery?

Medicare covers a conventional intraocular lens (IOL), a small, clear disc that replaces the damaged eye lens. However, coverage does not extend to upgraded artificial lens options that may eliminate the need for glasses following the surgery.

Does Medicare Pay for Cataract Surgery with Astigmatism Correction?

Medicare generally does not cover cataract surgery to correct astigmatism, as it is considered not medically necessary. However, you can choose more advanced IOLs, like multifocal or toric lenses, which can improve vision at multiple distances and reduce astigmatism.

Does Medicare Pay for Glasses After Cataract Surgery?

Yes, Medicare covers one pair of prescription glasses with standard frames or contact lenses prescribed by your doctor after your cataract surgery is complete.

An elderly patieat recieves his eye exams.

Applying for a Medicare Plan

During the annual open enrollment period, which runs from October 15 to December 7, you can select the Medicare Advantage plan that best suits your needs. If you foresee needing cataract surgery in the future, check to see which plan offers the most suitable coverage for you and wait to be Medicare-approved.

When signing up for Medigap, the best time to enroll is during your six-month enrollment period, which begins when you sign up for Original Medicare.


Understanding Medicare coverage for cataract surgery can be a complex task, given the various plans and factors involved. However, with the right information and advice, you can make an informed decision that best suits your needs.

If you have further questions about Medicare or insurance, don’t hesitate to contact us at the Fabian Ramirez Insurance Agency. Our team of experts are always ready to assist you with your insurance needs, ensuring you receive the personalized care and guidance you deserve.

What’s an EOB?

EOB Form

What’s an EOB?

You have insurance, had a doctor’s visit, received an EOB, now what?

Knowing how to read your EOB or Explanation of Benefits, is helpful to understanding your medical coverage and may keep your gray hairs at bay. Essentially your EOB is a statement from your health insurance plan which breaks down in complete description the costs they will cover for care and or products you’ve received. This explanation is created and delivered once your provider submits a claim regarding the services you’ve received.

Your EOB Is NOT a Bill

There’s no need to panic! Your insurance provider sends you an EOB to help make clear:

  • Cost of care you received
  • Amount of money you saved by visiting an in-work provider
  • Out-of-pocket medical expenses you will be responsible for

How to Read Your EOB

Please note, EOBs are not bills. They are simply a recorded statement of the medical services you’ve received and details on how your provider plans to share costs. You do not use this to pay an outstanding bill. Your bill can be broken down into a summarization of:

  • Your details and personal information
  • The medical services received and by who
  • Amount billed: The cost of those services
  • Discounts: Money you saved by accessing care from in-network providers
  • Amount covered and paid by your insurance
  • Amount not covered: What costs your health plan didn’t cover
  • Amount that was paid by HRA (if applicable)
  • The outstanding amount you are responsible for paying

Following this information is usually information regarding instructions on how to make an appeal, and then finally, there are more in-depth details about your total cost of care received.

The Purpose of an EOB

When you receive health care, your insurance provider will send you an EOB with the previously stated information. After this is received, you may receive a separate bill for the actual amount you owe. Information on this separate piece of paper will let you know where you can send your payment. Essentially EOBs are helpful because they provide you the value of your health insurance plan and can help you to gauge how much money you potentially have left in accounts related to your health insurance plan. These are also helpful for those who are wondering how close they are to meeting their deductible. That’s all the better because once your deductible is met, your provider will begin to help you pay for services received!

If you need help understanding this information or feel like you’re in need of a different type of coverage, contact me today at 361-652-3005 and we can get started on providing you with the care and coverage you actually need.

Should You Buy Dental Insurance? Key Questions to Ask Before You Buy

Dental Insurance Provider Victoria

3 Questions You Should Ask Before Buying Dental Insurance

Should You Buy Dental Insurance? Key Questions to Ask Before You Buy

While dental check-ups are usually needed every 6 months, you never know when a dental emergency might pop up in yours or one of your family member’s mouths that requires immediate attention and a whole lot of cash up front.

This is when dental insurance comes in handy. Of course, you will probably have to pay a small portion yourself, but with insurance, your provider will usually cover most of the procedure, helping you out financially. 

If you’re unsure if dental insurance is right for you, we have answered a few important questions to ask yourself before jumping into something unnecessary or overpriced.

  1. Does my employer offer similar coverage?

First, it is best to talk with your employer about if they offer a dental package. According to Guardian Direct, about 50% of companies offer dental insurance, so there is a good chance that you could save some money by going with them. This makes the most sense because employers actually pay a percentage of the premiums and can negotiate rates with group plans, therefore making you pay less. 

  1. How much are premiums?

Premiums are how much you are going to spend each month or each quarter, and they vary from provider to provider. They cover anything from dental preventative care, cleanings, root canals, and sometimes more depending on your coverage. 

If your employer does offer dental insurance, it might be a good idea to continue shopping around, as you might be able to find cheaper insurance privately. Knowing how much you are going to pay monthly or quarterly is important in making sure you aren’t getting in over your head and budget. 

In addition, an insurance provider that you can go through privately could offer better benefits, making the price difference worth it. Compare benefits from your employer’s dental insurance to the private one you’re looking into to figure out which one is worth what you will end up paying.

  1. Which dentists can I go to?

Perhaps you’ve already gone to a dentist you liked previously, or maybe you have certain criterias you want a dentist to meet when choosing them as your primary dentist. Either way, it is important to know what dentists are accepted in your dental insurance network that you are looking at getting insurance through. 

Your provider should have a database where you can look up in-network dentists in your area, or search specifically by the name of the dentist you already know and trust. This also makes it easy for when you aren’t sure who to go to, don’t know which dentists are in-network, and don’t feel like calling around to a dozen places and asking.

This can also be used when you are referred to another provider for a specific procedure and want to make sure they are in your network.

How do you buy dental insurance?

Now the big question is, how to go about getting insurance, for an affordable price and getting the most out of your plan. In today’s world, it is really easy to find an insurance provider by browsing the internet. You can go with the bigger guys, or choose a local agent who can help you navigate the best plan for you and your family and answer all your insurance questions. 

Still unsure of how to get dental insurance? Fabian Ramirez can help steer you in the right direction and discover what plan is right for you. Call today. (361) 652-3005.