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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that Lens extraction is considered medically necessary and therefore covered by Medicare when 
one (or more) of the following conditions or circumstances are documented in the medical record (see 
Documentation Requirements): 
 
    Cataract causing symptomatic (i.e., causing the patient to seek medical attention) impairment of visual 
function not correctable with a tolerable change in glasses or contact lenses resulting in the patient's inability to 
function satisfactorily while performing Activities of Daily Life (ADL) including, but not limited to reading, 
viewing television, driving, or meeting vocational or recreational needs. 
    Concomitant intraocular disease (e.g., diabetic retinopathy or intraocular tumor) requiring monitoring or 
treatment that is prevented by the presence of cataract. 
    Lens-induced disease threatening vision or ocular health (including, but not limited to, phacomorphic or 
phacolytic glaucoma). 
    High probability of accelerating cataract development as a result of a concomitant or subsequent procedure 
(e.g., pars plana vitrectomy, iridocyclectomy, procedure for ocular trauma) and treatments such as external 
beam irradiation. 
    Cataract interfering with the performance of vitreoretinal surgery. 
    Intolerable anisometropia or aniseikonia uncorrectable with glasses or contact lenses that exists as a result of 
lens extraction in the first eye (despite satisfactorily corrected monocular visual acuity. 
 
In the more common situation where surgery is performed sequentially in the other eye on separate days for 
bilateral visually symptomatic cataracts the appropriate interval between the first-eye surgery and second-eye 
surgery is influenced by several factors: 
 
    The patient's visual needs 
    The patient's preferences 
    Visual function in the second eye 
    The medical and refractive stability of the first eye 
    The need to restore binocular vision and resolve anisometropia, 
    An adequate interval of time has elapsed to evaluate and treat early postoperative complications in first eye, 
such as endophthalmitis; and/or 
    Logistical and travel considerations of the patient. 
 
The patient and the ophthalmologist should discuss the benefits, risks, need, and timing of second-eye surgery when they have had the opportunity to evaluate the results of surgery on the first eye, taking into account the 
above factors. 
 
If the decision to perform cataract extraction in both eyes is made prior to the first (sequential) cataract 
extraction, the documentation must support the medical necessity for each procedure to be performed. 
 
You can find this information in the Local Coverage Determination (LCD) Cataract Surgery in Adults L34203. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.