Does Medicare cover LASIK surgery?
LASIK surgery has become a standard procedure that many people undergo to help correct their vision since its approval by the FDA in 1998. For many people, wearing contacts or eyeglasses is no longer ideal, and they wish to make a change. However, the price can often be more than people are willing to spend. Michigan Health reports that the average cost per eye is about $2,200. So, does Medicare help cover the cost?
What is LASIK surgery?
Laser-Assisted In Situ Keratomileusis (LASIK) eye surgery is a procedure that helps to correct poor vision. This surgery utilizes laser technology to alter the shape of your eye to improve your eyesight. It typically serves as an alternative to contacts or eyeglasses.
However, it is unlikely for Original Medicare to cover the procedure because they do not typically categorize it as medically necessary. But, if your doctor were to deem LASIK surgery as medically necessary, there might be a chance Medicare would cover it.
What is medically necessary?
Medically necessary refers to any health service or supplies needed to treat or diagnose any illness, disease, injury, or symptoms.
Some examples of common medically necessary health services are hospice care, x-rays, ambulance services, and durable medical equipment. Health services that are not deemed medically necessary include cosmetic procedures and routine vision, hearing, and dental services.
The best way to determine if a service is medically necessary is to speak with your doctor and insurer to determine what is considered medically necessary for you. LASIK surgery is not typically considered a medically necessary procedure. Instead, it is classified as elective surgery.
What is elective surgery?
Elective surgery is any procedure that can be scheduled ahead of time because there is no emergency or immediate need for it. LASIK surgery usually falls into this category because it, in most cases, is a procedure people schedule in advance to combat poor vision.
If a person’s poor vision can be solved by other means such as wearing eyeglasses or contact lenses, then a LASIK procedure is not technically necessary. However, there are a few situations where getting this surgery may be covered.
Can Medicare Advantage plans cover LASIK surgery?
Medicare Advantage plans are alternative plans to Original Medicare. These Advantage plans are private Medicare insurance plans that provide you with Part A and Part B benefits. However, unlike traditional Medicare, Advantage plans operate within specific networks and service areas. If you are enrolled in an Advantage plan, you must use the doctors in your network or those willing to bill your plan if you have a PPO plan.
Since Medicare Advantage plans have specific networks for people to use in certain areas, it can be challenging to know what costs and procedures will be covered. However, it is common for some Medicare Advantage plans to include extra benefits, also known as ancillary benefits.
These benefits can consist of vision coverage that may cover LASIK surgery.
The best way to learn about your plan’s coverage is to review your plan’s Summary of Benefits and speak with your doctor.
What to do if LASIK surgery is not covered?
If you find that Medicare will not cover your LASIK surgery and you can’t afford the costs, it may be best to continue using contacts or glasses. Although, in the long run, it may be more financially beneficial for you to get LASIK surgery done. Other options may include employer discounts, special offers from clinics, or financing plans.
In most cases, Medicare will not cover LASIK surgery since they do not consider it medically necessary and instead deem it elective surgery. Some Medicare Advantage plans may help cover the surgery as a part of the extra benefits they may offer. Contact your doctor or healthcare provider today to know what your options are!