Does Insurance Cover LASIK Eye Surgery?

LASIK, or Laser-Assisted In Situ Keratomileusis, is a surgical procedure that reshapes the cornea to correct common vision problems like nearsightedness, farsightedness, and astigmatism. It aims to reduce or eliminate the need for glasses or contact lenses. A frequent question concerns its cost and whether insurance plans offer coverage.

General Insurance Stance on LASIK

Most standard health insurance policies do not cover LASIK eye surgery. This is because LASIK is typically classified as an elective procedure, not a medically necessary treatment for an illness or injury. Insurance companies define medical necessity as a service required to diagnose, treat, or prevent a health condition that would impair bodily function. Since refractive errors are correctable with glasses or contact lenses, LASIK is considered a choice for convenience or lifestyle.

Infrequent exceptions exist where LASIK might be medically necessary. These rare instances include vision problems from injury or previous surgery, severe refractive errors not correctable by conventional means, or medical conditions like severe dry eyes or allergies that prevent wearing glasses or contacts. Insurance providers require extensive documentation and a clear medical rationale from an ophthalmologist for such claims. Full coverage remains uncommon, and medical necessity criteria vary significantly among different plans.

Vision Plan Contributions to LASIK

While general health insurance typically excludes LASIK, dedicated vision insurance plans may offer financial assistance. These plans, distinct from comprehensive health coverage, often provide discounts or fixed allowances rather than full reimbursement. Many vision plans have negotiated rates with participating providers, allowing members to receive a percentage off the standard cost of LASIK, sometimes ranging from 15% to 50% for in-network surgeons.

Some vision plans may offer a specific dollar amount toward the procedure, which can lead to savings of several hundred dollars, often between $400 to $1,000 per eye. These are usually discounts or allowances intended to reduce the out-of-pocket expense, not to cover the entire cost of the surgery. Reviewing the benefits of your vision plan is advisable, as offerings can vary widely between providers and plan types.

Utilizing Health Savings Accounts and Flexible Spending Accounts

Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) offer a significant financial advantage for LASIK. LASIK is a qualified medical expense by the IRS, meaning funds from these accounts can be used for the procedure. Using pre-tax dollars contributed to these accounts reduces the overall cost of LASIK, as those funds are not subject to federal income, Social Security, or Medicare tax.

HSAs are available to individuals enrolled in a high-deductible health plan (HDHP) and allow funds to roll over year to year. For 2025, the HSA contribution limits are $4,300 for self-only coverage and $8,550 for family coverage, with an additional $1,000 catch-up contribution for those aged 55 and over. FSAs are employer-sponsored and typically operate on a “use it or lose it” basis, though some plans may permit a grace period of up to 2.5 months or a limited rollover of up to $660 for 2025. The 2025 FSA contribution limit is $3,300.

Direct Inquiry About Your Specific Policy

To determine your coverage and financial options for LASIK, directly contact your insurance providers. Begin by reaching out to both your general health insurance company and your vision plan administrator. Prepare a list of questions to ensure you gather all relevant information about your policy.

Ask if LASIK is covered under any circumstances, even if considered elective, and inquire about any criteria for medical necessity that might apply. Ask about available discounts or allowances for LASIK, especially with in-network providers. Confirm if pre-authorization is required before the procedure and what documentation, such as a letter from your surgeon, might be needed. Inquire about using Health Savings Account or Flexible Spending Account funds and any reimbursement requirements.