by Russell Noga | Updated December 28th, 2023
Does Medicare Cover LASIK Surgery?
If you’re considering LASIK eye surgery to correct your vision, you may be wondering about its potential costs and whether Medicare will cover the procedure.
With the popularity of LASIK surgery increasing, understanding the extent of your coverage is essential.
In this blog post, we will explore the intricacies of Medicare’s stance on LASIK surgery, various coverage options, and alternative vision correction procedures to help you make an informed decision.
One of the key questions we will address is, “Does Medicare cover LASIK surgery?”
- LASIK eye surgery is a popular surgical procedure, but Original Medicare typically does not cover it.
- Exceptions may be made in cases where the surgery is deemed medically necessary to treat certain eye conditions.
- Coverage for LASIK varies between Medicare Advantage Plans and standalone vision insurance plans. HSAs and FSAs can also be used to pay for expenses related to the procedure.
Overview of LASIK Eye Surgery
LASIK eye surgery, also known as Laser-Assisted in Situ Keratomileusis, is a popular surgical procedure that aims to correct various vision issues, such as nearsightedness, farsightedness, and astigmatism.
This elective surgery offers plenty of advantages. Patients who undergo the LASIK procedure can be less reliant on eyeglasses or contact lenses, enjoy better vision, and typically recover quickly.
However, LASIK surgery is not without risks, as potential side effects may include dry eyes and nighttime glare, while severe injuries that significantly affect vision are infrequent.
Medicare’s Stance on LASIK Coverage
Original Medicare, which includes Part A and Part B, typically does not cover LASIK surgery because it is considered an elective procedure and not medically necessary.
However, there are exceptions for certain chronic eye conditions, making some wonder, “Does medicare cover lasik in these cases?”
For instance, if your doctor determines that LASIK surgery is medically necessary for your overall health, Original Medicare may pay for the procedure.
Medical Necessity Criteria
In some cases, Medicare may cover LASIK surgery if it is deemed medically necessary to treat specific eye conditions, such as cataracts or glaucoma.
Medicare defines “medical necessity” as healthcare services and supplies essential for diagnosing and treating illnesses, injuries, or conditions related to eye health.
Although LASIK surgery is typically seen as elective, coverage may be provided by Medicare if your healthcare provider deems the procedure necessary to manage a specific eye condition.
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Breakdown of Medicare Parts and LASIK Coverage
Although both Medicare Part A and Part B commonly do not cover LASIK surgery, each part has unique rules on the procedure, discussed below.
Medicare Part A
Medicare Part A, also known as hospital insurance, does not cover LASIK surgery because it is an outpatient procedure and not related to hospitalization. Part A coverage focuses on:
- Inpatient hospital care
- Skilled nursing facility care
- Hospice care
- Laboratory tests
- Surgical procedures
- Home health care
As LASIK surgery does not fit within these categories, Medicare Part A does not provide any coverage for the procedure or related eye surgeries.
Medicare Part B
Medicare Part B, or medical insurance, may medicare cover lasik surgery but only if it is considered medically necessary. If deemed necessary, Medicare Part B will cover up to 80% of the cost of the surgery after meeting a deductible of $226 in 2023.
It’s important to consult with your healthcare provider to determine whether your specific case may qualify for Medicare pay coverage under Medicare Part B.
Medicare Advantage Plans and LASIK Surgery
Medicare Advantage Plans, or Medicare Part C, are offered by private insurance companies and often include additional benefits beyond those of Original Medicare.
Some of these plans may provide coverage for LASIK surgery as part of their vision benefits. However, the coverage details and eligibility criteria can vary significantly between different Medicare Advantage plans.
To figure out whether your Medicare Advantage plan covers LASIK surgery, ensure to:
- Review your plan documents, brochures, summaries of benefits, and annual notices.
- Consult your healthcare provider for guidance on available coverage.
- Contact specific Medicare Advantage plans for more information.
Costs Associated with LASIK and Medicare
It’s beneficial to understand the costs related to LASIK surgery and Medicare coverage, as both personal expenses and Medicare-related costs can influence your decision-making process.
Without insurance coverage, LASIK surgery can be quite costly, with out-of-pocket expenses ranging from $2,000 to $4,000 per eye. Several factors, such as the complexity of the case, geographic location, and surgeon’s fees, can influence the overall cost of the procedure.
Yet, these personal expenses can be lessened if you possess a Medicare Advantage plan or other insurance that covers LASIK surgery.
Reviewing your coverage options and understanding potential costs can help you make a better decision about choosing LASIK surgery.
For those with Medicare coverage, the costs related to LASIK surgery can include deductibles, copayments, and monthly premiums, depending on the specific coverage and plan.
While Original Medicare does not generally cover LASIK surgery, some Medicare Advantage plans may offer coverage, and the related costs may vary depending on the specific plan.
It’s beneficial to review your Medicare plan documents and speak with your healthcare provider to comprehend potential Medicare-related costs linked to LASIK surgery.
Alternative Vision Correction Options
If you’re exploring vision correction options beyond LASIK surgery, you may consider alternatives such as Photorefractive Keratectomy (PRK) and Laser-assisted Subepithelial Keratectomy (LASEK).
These procedures have some similarities to LASIK but also differ in certain aspects, such as the making of the corneal flap during the reshaping process.
Some Medicare Advantage plans may cover these alternative procedures as part of their vision benefits.
Researching your coverage options and discussing potential benefits and risks with your healthcare provider can help you make a better decision about the best vision correction choice for you.
Navigating Medicare for LASIK Coverage
Determining LASIK coverage within Medicare can be intricate, but with the right guidance and resources, you can effectively sift through your options.
One method includes reviewing your plan documents, speaking with your healthcare provider, and reaching out to specific Medicare Advantage plans for coverage information.
Keep in mind that Original Medicare does not typically cover LASIK surgery, so exploring Medicare Advantage plans with additional vision benefits may be the best option for finding coverage. By conducting comprehensive research and comparing plans, you can identify the most fitting coverage for your needs.
Additional Insurance Options for LASIK Surgery
Beyond Medicare, you might consider other insurance options like standalone vision insurance plans, which can offer coverage for LASIK surgery and other vision care services.
These plans often cover a range of services, including routine eye care, prescription eyeglasses, contact lenses, and fittings.
Standalone vision insurance plans may also cover specialized services like retinal imaging, progressive lenses, and anti-reflective coatings on eyeglasses.
These plans are available to individuals of all ages and can provide valuable vision coverage for various vision care needs, including routine vision care.
Using HSAs and FSAs for LASIK Expenses
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) offer another avenue for covering LASIK surgery expenses.
These tax-advantaged financial accounts can help you save money on approved medical expenses, including LASIK surgery, offering both financial flexibility and tax savings.
The key difference between HSAs and FSAs lies in their eligibility requirements, rollover options, and contribution limits.
Utilizing these accounts to cover LASIK expenses can help lower your personal costs and allow you to benefit from the tax advantages offered by these financial tools.
In summary, while Original Medicare does not typically cover LASIK surgery, there are options available for those seeking coverage.
By exploring Medicare Advantage plans, standalone vision insurance plans, and utilizing HSAs or FSAs, you can potentially reduce the costs associated with LASIK surgery.
Remember to consult with your healthcare provider, review your plan documents, and research various coverage options to make the best decision for your vision correction needs. With the right information and resources, you can confidently navigate the world of Medicare and LASIK coverage.
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Frequently Asked Questions
Why is LASIK surgery not covered by Medicare?
Since LASIK eye surgery is an elective procedure done to improve vision and not considered medically necessary, Medicare does not cover the cost of this procedure.
As Medicare focuses on covering services and treatments that are essential for diagnosing, treating, or preventing illness or injury, LASIK surgery falls outside of its scope of coverage.
What is the best age to do LASIK?
For optimal results, LASIK surgeons usually recommend a patient to be between 25-40 years old as their eyeglasses prescription has likely stabilized by then, which is one of the prerequisites for LASIK surgery.
Does Medicare Advantage cover laser surgery?
Medicare does not cover LASIK as it is considered an elective surgery. However, some Medicare Advantage plans may provide coverage for certain eye surgeries, including LASIK, so it’s worth checking your plan to confirm what is covered.
Is astigmatism surgery covered by Medicare?
Unfortunately, Medicare does not cover astigmatism surgery. Astigmatism correction is a basic part of vision correction, but surgical techniques such as toric lens implants are not included.
What are the out-of-pocket costs for LASIK surgery without insurance coverage?
LASIK surgery without insurance coverage can cost between $2,000 and $4,000 per eye.
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Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.