Medicare covers eye surgery when it is Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.. The most common examples of this are glaucoma surgery and cataract surgery, which are conditions that will permanently damage your eyesight without treatment. Medicare, like most health insurances, will not cover unnecessary and elective eye surgeries, such as LASIK to correct minor vision problems. Some Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). offer additional benefits, including eye care, and may cover some or all of your elective eye care procedures.
- Eye surgeries are medical procedures used to treat an eye disease or correct a person’s vision.
- Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. will only cover eye surgeries if they are part of medically necessary vision care.
- Laser therapy for glaucoma is covered by Medicare.
- Cataract surgery is covered by Medicare.
- Corrective eye surgeries to eliminate the need for eyeglasses, such as LASIK, are not covered by Medicare.
- Most Medicare Advantage plans have coverage for LASIK eye surgery, among other vision services.
- Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. policies are available to help with the costs of eye surgeries if Medicare provides coverage for them.
What Is Eye Surgery?
Eye surgery is a surgical procedure performed on the eye(s) to correct problems with a person’s vision or treat an eye disease that is deteriorating vision. These surgical procedures often use special lasers to either alter the structure of the eye’s cornea or to open the retina for a surgical lens implant. If an eye doctor finds early symptoms of eye disease during a routine eye exam, they may recommend eye surgery as a preventive treatment method to prevent any serious vision problems.1Mayoclinic.org, “LASIK eye surgery“, Accessed November 4, 2021
How Does Medicare Cover Eye Surgery?
Medicare covers surgical procedures if they are deemed medically necessary by the beneficiary’s A person or organization that’s licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers.. Medicare will provide coverage for eye surgery if it is for the medically necessary treatment of an eye condition, such as cataracts or glaucoma.2Medicare.gov, “Surgery“, Accessed November 4, 2021
Cataracts are caused by the proteins in your eye breaking down and bunching up over time. This causes clouding in your vision, making it difficult to see over time as your vision grows foggier. It is a particularly nasty and common eye condition, affecting more than 50 percent of people by the time they reach 80 years old, and the only real fix is surgery.
Medicare covers cataract surgery to implant an intraocular lens in the beneficiary’s retina. Medicare Part B also covers a pair of corrective eyeglasses or contact lenses after the cataract surgery.3Medicare.gov, “Eyeglasses & contact lenses“, Accessed November 4, 2021
Glaucoma is an eye condition caused by leaking fluid in your eyeball. This will put pressure on your eye and permanently damage your vision. Glaucoma has affected the vision of more than 3 million Americans today and the only way to treat it is to catch it as early as possible.
Medicare Part B covers laser therapy and surgeries for beneficiaries with glaucoma. Part B also provides coverage for an annual screening to monitor a beneficiary’s glaucoma.4Medicare.gov, “Glaucoma tests“, Accessed November 4, 2021
What Doesn’t Medicare Cover For Eye Surgeries?
If your eye doctor recommends an outpatient procedure to correct a vision problem such as nearsightedness, farsightedness, and astigmatism, it is not covered by Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.. As a result, popular LASIK and other corrective eye procedures are not covered.2Medicare.gov, “Surgery“, Accessed November 4, 2021
This is because it is medically unnecessary to perform surgery on your eyes for a condition that can be remedied with eyeglasses. If you want the luxury of not having to wear glasses during everyday life, you’re going to have to pay for it.
How Much Does Eye Surgery Cost?
The cost of eye surgery will greatly depend on the area, what type of eye surgery is being done, and if one or both eyes need treatment. Most eye surgeries are outpatient procedures that are covered by Medicare Part B. After the A person who has health care insurance through the Medicare or Medicaid programs. has met their Part B deductible, Part B covers 80 percent of approved costs.
The beneficiary is responsible for any Part B A Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment. incurred by the surgeon, anesthesiologist, and/or surgical center. If you need help with Excess Charges, consider joining a Medicare Advantage plan or purchasing a Medigap policy for protection against such charges.
Medicare Advantage plans are required to cover the same services as Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B, in addition to any expanded services offered. That includes eye surgeries. However, most Medicare Advantage plans that cover eye surgeries will not cover LASIK surgery. You will have to contact your plan provider to confirm your coverage for LASIK.
A beneficiary’s Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. with a Medicare Advantage plan may be different than those with Original Medicare. Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and Durable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds..6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 12, 2021
People with Original Medicare can purchase additional insurance, called Medigap, to help cover their Medicare out-of-pocket costs. Medicare supplement insurance, as it is also known, is available through private insurance companies. A Medigap policy will cover some or all of the out-of-pocket costs associated with Medicare-approved eye surgeries. These costs include:7Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 12, 2021
- A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.
- Coinsurance is a percentage of the total you are required to pay for a medical service.
- A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.
Thankfully, if you require eye surgery for a major eye disease or ailment, Medicare has you covered. Corrective vision surgeries such as LASIK are, sadly, not covered by Medicare. It is quite rare to find any insurance plan that covers LASIK surgery, even a Medicare Advantage plan that covers vision care.
If you are interested in LASIK eye surgeries to correct your vision, you will need to check the Medicare Advantage plans in your area to see if any offer such coverage. Otherwise, you will have to pay out-of-pocket for this elective surgery.
- 1Mayoclinic.org, “LASIK eye surgery“, Accessed November 4, 2021
- 2Medicare.gov, “Surgery“, Accessed November 4, 2021
- 3Medicare.gov, “Eyeglasses & contact lenses“, Accessed November 4, 2021
- 4Medicare.gov, “Glaucoma tests“, Accessed November 4, 2021
- 6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 12, 2021
- 7Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 12, 2021