Medicare generally does not cover routine vision care, but it will cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. A cataract is a cloudy area that forms on the lens of your eye, which can make your vision blurry and cause blindness over time. Cataract surgery repairs the function of the eye by removing the cataract and replacing your eye’s lens with a fabricated intraocular lens.
Specifically, Medicare covers:
- The removal of the cataract
- Basic intraocular lens implants (small clear disks that help your eyes focus)
- One set of prescription A prescription is an order for a health care service or drug written by a qualified health care professional. eyeglasses or one set of contact lenses after the surgery
Medicare covers cataract surgery that is performed using traditional surgical techniques or using lasers. Although Medicare covers basic intraocular lens implants, it does not cover more advanced implants. If your provider See Health Care Provider. recommends more advanced lens implants, you may have to pay some or all of the cost.
If you have Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , cataract surgery is covered under Part B. Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plans must cover the same services as Original Medicare, but they may have different costs and coverage rules. If you have a Medicare Advantage Plan, contact your plan to learn about how the plan covers cataract surgery.
Typically, Medicare does not cover eyeglasses or contact lenses. However, after cataract surgery Medicare will cover one standard pair of untinted prescription eyeglasses or one set of contact lenses. If it is medically necessary Medically necessary refers to procedures, services, or equipment that meet accepted medical standards and are necessary for the diagnosis and treatment of a medical condition. , Medicare may pay for customized eyeglasses or contact lenses.
If you have Original Medicare, you should get your glasses or contact lenses from a supplier who takes assignment. After you meet the Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. , you will pay 20% of the Medicare-approved amount See Approved Amount. for corrective lenses. If you have a Medicare Advantage Plan, contact your plan to learn about its costs and coverage rules for your glasses or contact lenses.
Some beneficiaries may have trouble getting Original Medicare or their Medicare Advantage Plan to cover their glasses or contact lenses following cataract surgery. If your glasses or contact lenses are denied coverage, you can appeal the decision.