Does Medicare Cover Cataract Surgery?
Cataracts are one of the most common eye conditions in seniors. Nearly half of adults have cataracts by age 75. They can make your vision blurry, cloudy, or dim. When glasses or contact lenses no longer help, cataract surgery may be needed. During this procedure, the cloudy lens is removed and replaced with a clear one. Cataract surgery is safe, effective, and widely performed in the United States.
If you are considering cataract surgery, it’s important to understand what Medicare covers and what your costs may be.
Cataract Surgery Cost with Medicare
Medicare covers cataract surgery when it is medically necessary, which means your doctor has determined it’s needed to treat your vision. Under Original Medicare (Parts A and B), most of the cost is covered. In general, Medicare pays about 80% of the approved amount, and you pay the remaining 20% after you meet your Part B deductible.
Because cataract surgery is usually done without an overnight hospital stay, it’s covered under Part B (medical insurance). The total cost can vary depending on where you have the procedure. For example, surgery at an ambulatory surgery center is often less expensive than in a hospital outpatient department.
The KelseyCare Advantage Difference
KelseyCare Advantage covers cataract surgery just like Original Medicare, but it also includes added financial protection. With Original Medicare, you usually pay 20% of the cost, and there is no yearly limit on what you may spend. With KelseyCare Advantage, many services have set copays, and each plan includes a yearly out-of-pocket maximum. This means there is a limit on what you pay each year. Once you reach that limit, the plan pays 100% of covered costs.
For example, instead of paying a percentage of the cost, you may have a set copay starting as low as $200 for cataract surgery at a Kelsey-Seybold Ambulatory Surgery Center, depending on your plan.
Kelsey-Seybold Ambulatory Surgery Centers
As a KelseyCare Advantage member, you have access to Kelsey-Seybold’s Ambulatory Surgery Centers located across the Greater Houston area. These centers are designed to make your care more convenient and connected.
Your doctors, surgeons, and care teams work closely together and share your health information, which helps create a smoother and more coordinated experience from start to finish.
In some cases, patients may be able to have surgery on both eyes during the same visit. This approach can reduce the number of appointments, lower overall costs, and shorten recovery time.
Get the Cataract Surgery Coverage You Need
Cataract surgery is covered by Medicare, but your total cost and overall experience can vary based on your plan and where you receive care. KelseyCare Advantage combines coverage with coordinated care to help make the process easier and more affordable. If you have questions about your options, our licensed local agents are here to help. Call 713-442-5646 (TTY: 711).
