Is LASIK Surgery Covered by Medicare?
- Is LASIK surgery covered by Medicare? If your health services are covered by Medicare, some vision services are included. Find out if LASIK is one of them.
Medicare does not help beneficiaries pay the cost of LASIK laser eye surgery. Because the LASIK procedure is regarded as a nonessential elective surgery, you may be expected to pay out of pocket for most or all of your costs.
What Is LASIK Surgery?
LASIK is a specific technique for eye surgery that involves reshaping the dome-shaped corneal tissue of the eye with laser ablation. In the most common form of the LASIK procedure, a special laser is used to gently burn off some of the outer layer of the cornea. This changes the way light moves into the eye and makes it easier to focus it onto the retina for a clear picture. LASIK is most commonly used as an alternative to glasses or contact lenses for people with a range of vision problems.
Medicare for Outpatient Services
LASIK is almost always performed on an outpatient basis, usually with the person getting the surgery returning home within hours after the procedure is finished. It is only necessary to go to the hospital after LASIK surgery if there have been complications, which are generally very rare. Because of this, LASIK laser eye surgery is considered an outpatient surgical procedure.
Medicare pays for the outpatient surgeries included in its plans under Part B, the outpatient benefit. Most of the people who have Part B coverage pay a monthly premium and a co-payment for provided services, such as ambulatory surgery, medical office visits and transportation to and from medical facilities. Because LASIK is an elective procedure, and because glasses and contact lenses are considered viable alternatives to LASIK, Medicare Part B does not pay for the procedure.
Unfortunately, Original Medicare also generally doesn’t pay for glasses or corrective contact lenses. This can leave many Medicare beneficiaries paying out of pocket for vision services, even if no viable alternative is available to them. Note that Medicare does sometimes pay for limited vision services, such as repair of injuries and other incidental care, but routine vision care is not included as a benefit under Part B.
Medicare Advantage Coverage
Medicare Advantage, which is commonly called Medicare Part C, is an alternative way that millions of beneficiaries choose to receive their Medicare coverage. With a Medicare Advantage plan, you have all of the same coverage Medicare Parts A and B offer, plus a few extra services provided by the private insurance company issuing the plan. Several Part C plans offer some form of vision care, though the details of this coverage vary by state and by company. Ask a plan representative what your Medicare Advantage plan includes, and whether you have vision services not covered by Original Medicare.
Note that, despite what is sometimes more generous coverage, few if any Medicare Advantage plans offer to pay for LASIK eye surgery.
Is LASIK Covered by Private Insurance?
Private insurance companies offer a wide range of services for a great variety of customers. Because of this diversity, it's difficult to generalize about coverage for specific medical procedures. As a rule, private insurance policies do not include elective procedures when a viable alternative to them exists. In the case of LASIK eye surgery, which is most often done to correct nearsightedness, farsightedness and astigmatism, glasses or contact lenses are almost always less expensive alternatives to surgery.
What Eye Surgery Is Covered by Medicare?
Medicare does not outright refuse coverage for all eye surgeries. Parts A and B, as well as the Medicare Advantage Part C plans, generally do pay for medically necessary procedures when no reasonable alternative exists. Thus, while an elective procedure such as LASIK is almost never covered, the reconstruction of the cornea after traumatic injury likely will be. Medicare also provides some assistance paying for corrective surgery for people with cataracts, glaucoma and other potentially disabling medical conditions.
Frequently Asked Questions
What is the difference between elective and non-elective procedures?
Elective medical procedures are loosely defined as those that can be scheduled in advance. This does not mean that a procedure is not necessary, but rather that you have some control over how and when it is performed. Non-elective procedures tend to be more urgent. Medicare commonly defines elective procedures as being extra, unnecessary or highly specialized operations for which a suitable alternative is already included in coverage. In the case of LASIK, routine eye surgery is already included under Part B.
Does Medicare pay for any elective procedures?
As a rule, Medicare does not pay for elective procedures. Coverage details vary from case to case, however. Ask a Medicare worker for specifics of what’s included in your Medicare plan.
Can I get help paying for procedures Medicare doesn’t cover?
Apart from private insurance policies, seniors with Medicare have several options to help pay for some medical expenses. Consider speaking with a certified senior adviser to plan your medical care expenses, which can include elective procedures such as LASIK eye surgery.