Does LASIK Get Covered by Insurance?

LASIK, or Laser-Assisted In Situ Keratomileusis, is a refractive surgery procedure designed to correct vision problems like nearsightedness, farsightedness, and astigmatism. This outpatient procedure reshapes the cornea using a specialized laser, to reduce or eliminate the need for eyeglasses or contact lenses. Many seek LASIK as a permanent vision correction solution for improved convenience and clarity.

General Insurance Coverage for LASIK

Most medical insurance providers classify LASIK as elective, not medically necessary. Insurers consider LASIK cosmetic because corrective lenses address refractive errors. Therefore, LASIK is usually not covered by standard medical insurance.

Rare exceptions for medically necessary LASIK are uncommon and require specific criteria. For example, if severe refractive errors cannot be corrected by traditional methods due to a medical condition, or if an individual experiences intolerance to contact lenses, coverage might be considered. Meeting medical necessity criteria often involves extensive documentation and pre-authorization.

Understanding Vision vs. Medical Insurance

Medical insurance plans are designed to cover expenses for illnesses, injuries, and disease treatments. These plans focus on maintaining overall health and addressing significant medical conditions. In contrast, vision insurance plans are structured to cover routine eye care, such as annual eye examinations, and provide allowances for prescription eyeglasses or contact lenses.

While vision insurance does not cover the full cost of LASIK, many plans offer discounts or preferred pricing through their network of providers. These arrangements mean that policyholders might receive a reduced rate for the procedure, but they are still responsible for the majority of the expense. These are often negotiated discounts, not direct coverage, significantly impacting the out-of-pocket cost for individuals considering LASIK.

Alternative Payment and Savings Options

Since direct insurance coverage for LASIK is uncommon, alternative financial strategies can help manage the cost. Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are tax-advantaged options allowing individuals to save and pay for qualified medical expenses, including LASIK. Contributions are made with pre-tax dollars, reducing taxable income, and funds can be used for eligible medical services as defined by the IRS. For example, the IRS considers LASIK a qualified medical expense under Section 213(d) of the tax code.

Many LASIK providers offer financing plans to make the procedure accessible, which can include interest-free periods ranging from 12 to 24 months. These payment plans allow individuals to pay for the surgery over time, without incurring additional interest if payments are made on schedule. Inquiring about potential discounts, such as seasonal promotions, cash payment incentives, or specific professional affiliations, can further reduce the overall expense.

Verifying Your Specific Coverage

To determine potential benefits for LASIK, individuals should directly contact their insurance provider. The customer service number is on the back of the insurance card, or information can be found through the insurer’s online portal. Have your policy number readily available when making inquiries.

When speaking with a representative, ask questions such as, “Is LASIK covered under my medical or vision plan?” and “What are the criteria for medical necessity if coverage is considered?” Inquire whether your vision plan offers negotiated discounts or preferred pricing with LASIK providers within their network. Ask about the process for pre-authorization or claims submission if medical necessity is a possibility. Note the date, time, and name of the representative, and request important information in writing for your records.