Does Medicare Cover Eye Surgery? 

Eye health is something that’s vitally important at any age, but seniors are commonly affected by vision problems. Eyesight naturally degrades with age, but health conditions like high blood pressure, diabetes or glaucoma can add to a decline or loss in vision.

Seniors who experience vision issues may find it difficult to do everyday tasks like reading and driving. This can be a huge inconvenience but it can also be a safety concern. If you’re experiencing any type of vision problems or you notice your vision has gotten worse with time, you’re encouraged to make an appointment with your primary care physician to discuss your treatments. Don’t wait until your vision has declined dramatically before addressing it. A loss in vision can affect your ability to perform daily activities and can put your independence at risk.

Treatment options for seniors experiencing vision concerns

Vision concerns are treated in different ways depending on the cause and severity of your condition. For some seniors, corrective lenses in the form of glasses or contacts can restore normal vision. In more severe cases where dysfunction or injury has impacted eyesight, surgery may be required.

If more conservative treatments are not effective, vision surgery may be required. You may need surgery for removing cataracts and replacing the eye’s natural lens with an intraocular lens. Surgery could be the result of an injury or illness. Many eye surgeries are minimally invasive, but some may require a relatively lengthy recovery period.

How does Medicare cover eye surgery?

Seniors who experience certain vision problems may be able to turn to Medicare benefits for help if eye surgery is needed. Medicare covers eye surgery and some emergency vision care services, but there is no routine vision care benefit included in Original Medicare. This means that Medicare does not cover eye exams outside of those performed by your doctor during a wellness appointment. Original Medicare does not supply a benefit for prescription glasses or contacts. Over-the-counter reading glasses are also excluded from Medicare coverage. Many Medicare Advantage plans include vision care benefits, glasses and contacts within their umbrella of coverage along with your Part A and Part B benefits. 

Medicare Part B coverage for eye surgery
If you require medically necessary eye surgery, coverage may be based on where your procedure is performed. Most vision surgery is outpatient in nature, meaning you don’t require hospitalization in order to have eye surgery performed. Common surgical procedures like cataract removal can often be done in a day, and Medicare recipients can leave after the surgery is completed to rest and recuperate at home.

Medicare covers outpatient eye surgery through Medicare Part B. In using Medicare Part B, seniors can receive coverage for different types of vision surgery, but all covered procedures must be medically necessary. 

It’s important to note that while LASIK is a type of eye surgery in which impaired vision is corrected using lasers, it is considered elective. This means that vision correction surgery using LASIK is not covered.  

For medically necessary outpatient services, Medicare benefits cover 80% of the cost of care while Medicare recipients cover the remaining 20%. You will also need to be current on your Medicare Part B monthly premium and meet your deductible in order to utilize your Part B Medicare benefits.

How is inpatient eye surgery covered?

If you require eye surgery as part of an admittance to a Medicare-participating hospital or skilled nursing facility, Medicare will pay for qualifying services through Medicare Part A. Most Medicare recipients pay no monthly premium for Part A coverage, but a deductible of $1,632 applies in 2024.

Does Medicare cover glasses or contacts following vision surgery?

Aside from covering certain vision surgeries, Medicare benefits are also available for corrective lenses following cataract surgery in which an intraocular lens was placed. This coverage does not extend to regular eye exams or glasses and contacts prescribed by optometrists. Instead, this coverage supplies a pair of basic frames and lenses used to aid in recovery after a new lens is placed during surgery. This benefit is not ongoing and does not cover contacts.

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