Is Cataract Surgery Covered by My Medicare Advantage Plan?

Cataract surgery is a popular topic amongst senior and retirees

Medicare recipients or retirees who are new to Medicare, and on a Medicare Advantage plan, commonly ask whether cataract surgery is covered, the process in going about in getting an approval for the surgery, their coverage options, and whether the surgery is actually safe.

Here’s some relevant data you should know

There have been approximately 3.8 million cataract procedures performed on adults aged 65 and over ( iData Research). Over 50 percent of seniors age 80 and over have cataracts, and have received cataract surgery. Cataract surgery is known as a very safe procedure. A research study compiled from 1994 and 2006, revealed that 99.5 percent of  200,000 Medicare beneficiaries who underwent surgery did not experience any serious complications.

Retiree getting ready for his cataract surgery in NYC

So is cataract surgery covered by your Insurer or Medicare Advantage plan?

The simple answer is yes. Medicare Part C, or Medicare Advantage Plans cover the same service as original Medicare part A and B. Most Medicare Advantage Plans cover all or part of your cataract surgery. What’s important to keep in mind is that Medicare only covers one specific set of procedures. So knowing the type of cataract surgery you need is important.

There are multiple types of cataract surgery

Your Medicare Advantage plan may cover:

• Cataract Removal
• Lens Implants
• One set of eyeglasses or contact lenses.

Are  laser cataract surgery covered?

Your Medicare Advantage plan can also cover laser cataract surgery, whether it’s performed by a laser or more traditional techniques. What is important to know is the type of lens that is covered, and they usually cover monofocal lens implants.

Are there any other procedures I should know about that are not covered under my Medicare Advantage Plan. Commonly the following procedures are not covered by Medicare:

• Accommodative
• Multifocal
• Toric

Can my plan cover Lasik?

Lasik is a corrective eye surgery that is approved by the FDA and is considered to be an elective procedure which is typically not covered by medical insurance, unless the provider deems it as medically necessary, and your receive authorization from your insurance provider.

Where can you check to see if your plan covers cataract surgery?

You can check in your “Summary of Benefits” packet that you initially receive after enrolling in your Medicare Advantage plan. To get a more in-depth view of the services your Medicare Advantage Plan covers, you can also check the “Evidence of Coverage booklet”. When checking your benefits, please make sure you have updated materials for the year your currently in.

In Summary

Cataract surgery is a common procedure performed on many senior and retirees. Your Medicare Advantage plan typically does provide comprehensive eye coverage which includes cataract surgery, but they are limited on covering only certain approved procedures. Cataract surgery is a safe procedure, and it is always important to check specific  benefits details in your plan’s summary of benefits or evidence of coverage, and your doctor before you have any procedures to avoided any unexpected surprises or fees.