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.

The Truth On Health Insurance

Dental Insurance

The Truth On Health Insurance 

Unfortunately, getting sick or injured is inevitable. However, with the help of health insurance, you can help defray unexpected medical expenses and ensure protection for yourself and your loved ones. Medical-related expenses can, and will, rack up some pretty hefty bills. For example, one trip to the emergency room can cost you thousands of dollars and leave you financially set back for years. One thing is for certain in this unpredictable world: staying prepared for accidents and illness is imperative.

What Exactly Does Health Insurance Cover?

What some people might not realize is the cost of care does not stop after you leave health care facilities. Luckily neither does health insurance. Coverage extends to basic needs like preventative services (vaccines, screenings, etc.), prescriptions and lab tests as well. These are all elements of health care that can end up costing a pretty penny on their own, especially for single people and those who are single parents. 

Furthermore, services like mental health and substance use disorder services are covered by different health insurance plans. Counseling, psychotherapy and behavioral health treatments all fall under the umbrella of mental health and substance use disorder services and can be covered by your health insurance provider. 

What about your little ones? Insurance offers extended coverage to your family members, children included. Care for new and expecting parents is covered both before and after children are born. It is also important to note that insurance can help offset the costs of other pediatric (and general) needs. Speech-language pathology and occupational therapy are among the most common therapy needs for children all of which are covered under most plans.

    Words to Know

    For people who are new to the world of insurance, technical jargon can lead to confusion and frustration when trying to select the best plan for their lives. This is especially true for young adults who are trying to navigate the world on their own. Words like copayment, deductible and health care savings account can throw people for a loop who are just getting started. Below, we have listed a few words to know as you begin your journey in the health insurance world:

    • Copayment (often referred to as copay) – a fixed amount you pay for a covered health care service when received (ex. $25 per doctor’s visit).
    • Deductible – the amount you could owe before health insurance kicks in.
    • Formulary – a list of the names of prescription drugs your plan covers. 
    • Network – the health care places and providers your insurer uses to provide you with your care. 
    • Premium – the cost that must be paid for your insurance; this is usually paid monthly, quarterly, or yearly by your and/or your employer. 

    For a full list of medical insurance terms visit here.

    Protection You Choose

    Independent healthcare insurance is coverage that is purchased on your own. Obviously, this differs from government or employer-sponsored plans in the sense that you are in control of what and how much coverage you receive. In Texas, more than five million people go uninsured every year; most of whom are probably unsure they can even get insurance without having to go through their employer. 


    Private health insurance typically gives purchasers a wider range of options than government-sponsored plans. This means purchasers can tailor their insurance plans to their needs. Plus, the private route will typically lead to shorter wait times and more individualized care if buyers choose to get coverage from local organizations.

    Rest At Ease

    The peace of mind that comes with having health insurance is unmatched. Now that you have some insight into the insurance world, you can feel better about selecting the health care options that fit your lifestyle the best. 

    When you purchase health insurance through Fabian Ramirez Insurance Agency, LLC you can rest assured and be confident in the coverage you choose. Fabian and his team of insurance experts are ready to help you gain quality coverage and promise to be there for you every step of the way.


    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.