Does Medicare Cover Eye Care Following Cataract Surgery?

As a rule, Medicare does not cover eyeglasses or contact lenses. But if you have cataract surgery with an intraocular lens, Medicare will cover services provided by an optometrist if the optometrist is licensed to provide service in your state. Medicare will also help pay for cataract glasses, contact lenses and intraocular lenses provided by an optometrist following cataract surgery.

There are several provisions regarding coverage. They include:

• Medicare will cover one pair of glasses or lenses following cataract surgery.
• Medicare will only cover standard frames, you pay the additional cost for upgraded frames.
• Lenses are covered even if you had your cataract surgery before you were enrolled in Medicare.
• Medicare may make payment for lenses for both eyes even if you had surgery on only one eye.
• Medicare does not cover tinted lenses used in sunglasses, scratch resistant coating on lenses, or contact lens cleaning and saline solutions.
• The order (prescription) must be signed and dated by the treating doctor.
• The order (prescription) must be kept on file with the supplier in the event it must be made available to the DMERC
• Your supplier MUST be enrolled in Medicare and accept assignment in order for your equipment to be covered. Suppliers must meet strict standards to qualify for a Medicare supplier number.

How Much Do You Pay?

You pay for 20% of the Medicare-approved amount under Medicare Part B for one pair of eyeglasses or contact lenses following each cataract surgery with intraocular lens. You must pay your deductible for any Medicare Part B services and supplies before Medicare begins to pay its share.

If a doctor, health care provider or supplier does not accept assignment, the amount you pay may be higher. If you choose to purchase upgraded frames, your supplier should ask you to sign an Advanced Beneficiary Notice informing you of the difference you will pay.

There are several Local Coverage Determinations and 2 National Coverage Determinations written that explain when services or supplies are covered, including when they are considered medically necessary. Please consult with your optometrist for more information.