Cataract Surgery: insurance and costs

Bills for surgery come from several places: the surgeon, the hospital or surgery center, anesthesia, imaging, therapy and equipment, often over months. This page shows a published reference price for cataract surgery, explains how insurance turns a price into what you owe, and lists the protections and questions that matter most. Your own plan and your surgical team decide the final number.

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A reference price: what Medicare pays

Medicare publishes national average prices for outpatient procedures. They're a useful anchor because they're public and include both the surgeon's fee and the facility fee.^[1]

National averages based on Medicare's 2026 payments, checked November 14, 2026. "You pay" is the average Original Medicare patient share after the Part B deductible. Anesthesia, other doctors, tests and follow-up care may bill separately, and your costs vary by location.^[1]

How this compares with private insurance

Private insurers usually pay more than Medicare. A RAND study of 2022 claims found employers and private insurers paid hospitals on average about 254% of what Medicare would have paid for the same services, with wide variation between states and hospitals.^[2] Prices for common outpatient services at surgery centers averaged about 170% of Medicare.^[3] Your share depends on your plan's negotiated rate, not Medicare's, so treat the table as a floor for the total, not a quote.

Surgery centers are usually cheaper than hospital outpatient departments, as the table shows, but not everyone is a good candidate for a surgery center. Ask where your surgeon operates and why.

What's specific to cataract surgery

Standard lens covered, upgrades extra. Medicare Part B covers cataract surgery with a conventional lens. After you meet the Part B deductible you pay 20% of the Medicare-approved amount to both the facility and the surgeon.^[4] Under CMS rulings, if you choose a presbyopia-correcting lens (such as multifocal or extended depth of focus) or an astigmatism-correcting (toric) lens, you pay the part of the facility and surgeon charges that goes beyond a conventional lens.^[5] Get that extra amount in writing before surgery.

Glasses after surgery. Medicare usually doesn't cover glasses, but it does cover one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery with a lens implant. You pay 20% after the deductible, plus any upgrade to the frames.^[6]

Two eyes, two bills. The prices above are for one eye. Most people have the second eye done separately, with a second set of charges.

How your plan turns a price into your bill

• Deductible: the amount you pay for covered care before your plan starts to pay.^[7]
• Coinsurance: your percentage share of the allowed amount after the deductible, for example 20%.^[8]
• Out-of-pocket maximum: the most you pay in a plan year for covered, in-network care. For 2026, Marketplace plans can't set it higher than $10,600 for one person or $21,200 for a family. Employer plans may set lower limits.^[9]

If you have Original Medicare

In 2026 the Part B deductible is $283 a year, and after that you usually pay 20% of the Medicare-approved amount for outpatient care. If you're formally admitted to a hospital, the Part A deductible is $1,736 per benefit period.^[10][11]

Whether you're an inpatient or an outpatient changes what you pay. You're an outpatient, even if you stay overnight, unless a doctor has written an order to admit you. Observation services are outpatient care.^[12] Ask your team which status you'll have. Medicare Advantage and supplemental (Medigap) plans have their own rules, so call your plan.^[13]

Protect yourself from surprise bills

Prior authorization isn't a promise to pay

Your plan may require approval before surgery. Preauthorization is a decision that a service is medically necessary, but it isn't a promise your plan will cover the cost.^[14] Ask your plan to confirm separately that the surgeon, the facility and anesthesia are in network, and what your share will be.

The No Surprises Act

If you have private insurance, the No Surprises Act protects you from unexpected out-of-network bills for non-emergency care related to a visit to an in-network hospital, hospital outpatient department or surgery center. For example, an out-of-network anesthesiologist at your in-network hospital.^[15]

You can lose that protection if you sign a notice and consent form agreeing to out-of-network care. The protections also don't apply in a doctor's office that isn't a hospital outpatient department, or at an out-of-network facility.^[15] Read anything you're asked to sign before surgery.

If you're paying yourself

If you don't have or don't use insurance, providers usually must give you a good faith estimate when you schedule care at least three business days ahead or ask for one. You may be able to dispute a bill that's at least $400 more than the estimate.^[16] Keep the estimate.

Look up prices and ask for help

Hospitals must post their prices online, including a list of common shoppable services, under federal price transparency rules.^[17] Tax-exempt hospitals must have a written financial assistance policy offering free or discounted care to patients who qualify.^[18] Ask the billing office for it before surgery, not just after the bill arrives.

Costs people forget

• Premium lens or laser fees, if you choose them
• Prescription eye drops for several weeks
• Rides to surgery and next-day checks, since you can't drive yourself
• New glasses beyond Medicare's one standard pair

See recovery supplies at every budget and ask your team which items are supplied, rented or covered.

Time off work

Lost income is often the biggest cost that never shows up on a bill. The recovery section of the guide describes typical recovery. Under the Family and Medical Leave Act, eligible employees can take up to 12 workweeks of job-protected leave in a 12-month period for a serious health condition.^[19] Ask HR early about short-term disability, paid leave and keeping your health insurance while you're off.

Questions to ask before surgery

1. What procedure codes will you bill, and where will the surgery be done?
2. Is everyone involved in network, including anesthesia, the assistant surgeon and any device or implant charges?
3. Does my plan require prior authorization, and has it been approved for this setting?
4. Will I be an inpatient, an outpatient, or under observation?
5. What is my estimated share for the surgery, and what does it not include?
6. How much do therapy, equipment and follow-up visits cost me?
7. If I'm paying myself, can I have a written good faith estimate?
8. Do you have a financial assistance policy or payment plan?

This page explains how costs and coverage usually work. It isn't legal, tax or financial advice. Plans differ, so confirm details with your insurer and your surgical team. Figures checked November 2026.

Sources

1. Medicare.gov. Procedure Price Lookup for outpatient services (national averages based on Medicare's 2026 payments). Checked November 14, 2026. www.medicare.gov
2. Whaley CM, et al. Prices paid to hospitals by private health plans: findings from Round 5.1 of an employer-led transparency initiative. RAND Corporation; 2024. www.rand.org
3. RAND Corporation. Private health plans paid hospitals 254% of what Medicare would pay during 2022 (news release via EurekAlert). www.eurekalert.org
4. Medicare.gov. Cataract surgery coverage. www.medicare.gov
5. Centers for Medicare & Medicaid Services. Laser-assisted cataract surgery and CMS Rulings 05-01 and 1536-R (presbyopia- and astigmatism-correcting IOLs). www.hhs.gov
6. Medicare.gov. Eyeglasses and contact lenses coverage. www.medicare.gov
7. HealthCare.gov. Deductible. www.healthcare.gov
8. HealthCare.gov. Coinsurance. www.healthcare.gov
9. HealthCare.gov. Out-of-pocket maximum/limit (2026 Marketplace limits). www.healthcare.gov
10. Medicare.gov. Medicare costs: Part A and Part B deductibles and coinsurance for 2026. www.medicare.gov
11. Centers for Medicare & Medicaid Services. 2026 Medicare Parts A & B premiums and deductibles (fact sheet, November 14, 2025). www.cms.gov
12. Medicare.gov. Inpatient or outpatient hospital status affects your costs. www.medicare.gov
13. Medicare.gov. Surgical coverage: estimating your costs. www.medicare.gov
14. HealthCare.gov. Preauthorization. www.healthcare.gov
15. Centers for Medicare & Medicaid Services. Know your medical bill rights when using insurance (No Surprises Act). www.cms.gov
16. Centers for Medicare & Medicaid Services. Medical bill rights (good faith estimates if you don't use insurance). www.cms.gov
17. Centers for Medicare & Medicaid Services. Hospital price transparency: information for consumers. www.cms.gov
18. Internal Revenue Service. Financial assistance policies (FAPs) for tax-exempt hospitals. www.irs.gov
19. US Department of Labor. Family and Medical Leave Act. www.dol.gov