How Much Does Cataract Surgery Cost with Medicare?

Cataracts are a common eye condition, especially for those who are over age 65. The good news is cataract surgery is a safe and effective procedure that can restore your vision.  

If you have Medicare, you may be wondering how much cataract surgery will cost you.

In this blog post, we'll break down the costs associated with cataract surgery for those with Medicare coverage.

Does Medicare Cover Cataract Surgery?

Medicare covers cataract surgery, as it's considered medically necessary. However, there are still costs associated with the procedure.  

The amount you'll pay depends on several factors, including the type of Medicare coverage you have and what billing code is used for your cataract surgery.

Traditional vs Laser Cataract Surgery

Traditional cataract surgery and laser-assisted cataract surgery are both safe and effective procedures for treating cataracts, but there are some differences between the two techniques.  

In traditional cataract surgery, the surgeon makes incisions in the eye using a surgical blade, while in laser cataract surgery, a laser is used to make the incisions. Also, in traditional surgery, the surgeon manually breaks up the cloudy lens using ultrasound waves and removes it, while in laser-assisted surgery, the laser is used to break up the lens before it is removed.

One of the main benefits of laser cataract surgery is increased precision and accuracy, which can lead to better visual outcomes. The laser can also reduce the amount of energy needed to break up the lens, which may result in less trauma to the eye.  

The big drawback? Laser cataract surgery is typically more expensive than traditional surgery and may not be covered by insurance.

Factors Affecting Cost of Cataract Surgery

When it comes to the type of cataract surgery you choose, traditional cataract surgery is typically less expensive than laser cataract surgery.  

There are also different billing codes used depending on how complex the procedure is and what devices are used.

Finally, your location will have an impact on what you pay. Medicare’s approved pricing varies based on region, so some parts of the country are more expensive than others.

Your Cataract Surgery Costs with Medicare

If you have Original Medicare (Parts A and B), you'll be responsible for paying the Part B deductible, which is $226 in 2023. After you meet your deductible, you'll pay 20% of the Medicare-approved amount for the surgery.  

So, what is the Medicare-approved amount for cataract surgery? Well, it depends on what billing code is used.

Cataract Surgery Billing Codes

For example, code 66989 is for a pretty complex cataract removal surgery where a doctor uses devices or techniques not generally used in routine cataract surgery. Under this billing code, Medicare will pay between $3,280 and $4,085.  

Your out-of-pocket costs would be between $819 and $1,021.

Keep in mind that if you have a Medicare Supplement, it will cover most of those out-of-pocket costs.

Another example is code 66983, which is for intracapsular cataract extraction with insertion of intraocular lens prosthesis. This simpler billing code will cost Medicare between $849 and $1,696.  

You’d be responsible for an amount between $212 and $424.

And again, if you have a supplemental policy, it would pick up most of your out-of-pocket costs, aside from the Part B deductible.

If you have a Medicare Advantage plan, your costs may be different. It's important to check with your plan to understand your costs.

Conclusion

Cataract surgery is a common and necessary procedure that is covered by Medicare.  

While there are still costs associated with the surgery, the amount you'll pay depends on several factors, including the type of Medicare coverage you have and the type of surgery you need.  

It's important to talk to your surgeon and your Medicare plan to get an estimate of your costs and to understand your coverage.

A Medicare Supplement can drastically reduce your out-of-pocket costs when you need cataract surgery – contact us for a free quote today!