Does Medicare Cover Lasik Surgery?
LASIK eye surgery is generally not covered by Original Medicare since it’s categorized as an elective procedure to improve vision and not cure blindness. However, in some rare cases, Original Medicare may cover LASIK surgery when your doctor declares it medically necessary, and your health depends on the procedure. For example, if an injury caused your vision problem or if your nearsightedness, farsightedness, or astigmatism is so severe that it cannot be adequately corrected with glasses or contact lenses.
Unlike Original Medicare, which does not cover routine vision care, Medicare Advantage plans, also known as Medicare Part C, often include additional benefits and may help pay for all or part of your LASIK cost. If your Medicare Part C covers LASIK surgery, your out-of-pocket costs, including deductibles, copayment, and coinsurance, will depend on the insurer and your coverage.
If you have vision problems and believe this procedure could improve your quality of life, read on to learn about LASIK surgery and how some Medicare plans may help shoulder the cost.
Table of Contents
What Is Lasik Surgery?
LASIK, short for Laser-Assisted In Situ Keratomileusis, is a type of eye surgery that corrects common vision problems caused by refractive errors, including nearsightedness, farsightedness, and astigmatism. A refractive error is when your eye fails to refract or bend light properly. During the procedure, your ophthalmologist will use a laser to change the shape of your cornea to improve how light rays are focused on your retina.
It’s important to note that not all laser eye surgery is LASIK, but all LASIK is laser eye surgery. What makes LASIK special is its hyper-focused ultraviolet light that vaporizes targeted cells but causes no damage to that area. For this reason, LASIK is generally considered a safe procedure, and complications are rare.
Understanding Medicare Coverage For Lasik Surgery
While it’s rare that Original Medicare, which consists of Part A and Part B, covers LASIK surgery, it’s still worth understanding how coverage works if you find yourself in a special circumstance where this procedure is deemed medically necessary.
Medicare Part A and Part B do not cover vision services except under specific circumstances. For example, if an injury causes your eyes’ refractive errors, a complication from a previous surgery, or if contact lenses and glasses cannot fix your condition. Besides being declared a medical necessity by your doctor, a healthcare provider that accepts Medicare assignment must also perform the LASIK surgery. Contact your eye doctor or Medicare for more details on eligibility requirements.
Part A Coverage
Medicare Part A covers inpatient care, such as hospital stays or skilled nursing facilities. Since LASIK surgery takes less than 30 minutes and does not require you to stay overnight, you will most likely not use Medicare Part A to cover expenses.
Part B Coverage
Medicare Part B covers medically necessary services like outpatient care, doctor’s visits, lab tests, and preventive care. If your doctor deems your LASIK surgery medically necessary, Medicare Part B may help pay for 80% of the surgery costs once you’ve met your deductible of $226 for 2023.
How Does Medicare Advantage Cover Lasik Surgery?
Medicare Advantage Plans are required to offer benefits that are at least equivalent to Medicare Part A and B. Still, many offer additional benefits, such as vision, dental, and hearing coverage. Depending on the Medicare Advantage Plan you’re enrolled in, LASIK eye surgery may or may not be included in those benefits. The eligibility criteria to receive coverage may also vary depending on your specific plan. Contact your plan provider to find out the exact coverage details.
How Much Does Lasik Cost With Medicare?
The following services and items are typically included in the price for your LASIK procedure:
- Pre- and postoperative care for at least a year
- Facility and surgeon fees
- Postoperative eye drops
- Follow-up procedures if there’s a need for fine-tuning the correction
Without insurance coverage, the total out-of-pocket cost for LASIK based on the components listed above can range from $2,000 to $4,000 per eye. If you need LASIK on both eyes, expect to shell out anywhere from $4,000 to $8,000. Note that this range can vary depending on factors like the complexity of the case, your geographic location, and the specific surgeon’s fees. With insurance coverage, you can get a significant portion of this cost reduced.
Part A Costs
Medicare Part A does not have a premium cost for beneficiaries who have worked for at least ten years and paid into Medicare through their taxes. However, you’ll have to pay a deductible of $1,600 for each benefit period you’re hospitalized in 2023. Since LASIK surgeries typically do not require hospital stays, Medicare Part A costs will most likely not apply to you.
Part B Costs
If your LASIK procedure is considered a medical necessity and Original Medicare covers it, Part B will shoulder 80% of your overall surgery costs after you’ve met your $226 deductible. This means if your surgery costs $8,000, you’re responsible for paying $1,600 of that, in addition to the deductible and monthly premium of $164.90 for most beneficiaries.
Medicare Advantage Costs
Your LASIK out-of-pocket costs with a Medicare Advantage plan will depend on your coverage, but you typically won’t pay much more than the total you’d pay with Original Medicare. Note that since you must be enrolled in Original Medicare to be eligible for Medicare Advantage Plans, you’ll usually pay a monthly premium for the Medicare Advantage Plan in addition to your Part B premium. The average premium for Medicare Advantage plans in 2023t is $18 per month.
Alternatives to Lasik
LASIK surgery is not for everyone. Consider the following alternatives if you’re disqualified from getting the surgery due to your age or eye conditions.
- PRK (Photorefractive Keratectomy): PRK is one of the most common LASIK alternatives for patients with thin corneas and dry eyes who are not good candidates for LASIK.
- LASEK (Laser Epithelial Keratomileusis): LASEK is another viable choice for patients with thinner corneas who may be unsuitable for LASIK. However, LASEK is a more invasive procedure that typically requires longer recovery.
- Refractive Lens Exchange (RLE): Like cataract surgery, this procedure involves replacing your eye’s natural lens with an artificial intraocular lens to correct the refractive error.
- Implantable Lenses (Phakic IOLs): Unlike RLE, implantable lenses are inserted into your eye without removing the natural lens. Ideal candidates for phakic IOL implantation are young patients aged 21 to 45 with moderate to high myopia.
Though Medicare generally will not cover the costs of eye surgeries like the ones mentioned above unless they’re medically necessary, some Medicare Advantage plans might. Check with your plan provider or doctor to see whether you may be eligible for coverage.
How To Get Your Lasik Surgery Covered By Medicare
- Talk to Your Doctor: First, talk to your ophthalmologist about your need for LASIK surgery. If they think the procedure is medically necessary for your situation, they could help you write a medical necessity letter.
- Document Medical Necessity: Since LASIK is considered an elective surgery, Medicare will most likely deny your claim for lack of medical necessity without a formal letter from your doctor. In the letter, have your doctor document why Lasik surgery is medically necessary.
- Submit The Letter and Await Approval: Lastly, submit the letter to the appropriate contact at Medicare. A letter of medical necessity does not guarantee your LASIK surgery costs will be approved, but it could increase your chances of getting coverage.
Putting It All Together
While LASIK is one of the safest ways to help you regain clear vision, Original Medicare typically does not cover the procedure unless your doctor deems it medically necessary. And while some Medicare Advantage Plans may help shoulder a portion of the cost, not all of them will. LASIK can be costly without insurance coverage, so always talk to your healthcare provider and insurer to fully understand your financial responsibilities before deciding on the procedure.