Does Medical Cover LASIK Eye Surgery?
Understand how medical insurance typically handles LASIK eye surgery coverage, identifying key factors and alternative payment methods.
LASIK eye surgery, or Laser-Assisted In Situ Keratomileusis, reshapes the cornea to correct vision issues like nearsightedness, farsightedness, and astigmatism. Many individuals consider LASIK to reduce or eliminate their reliance on glasses or contact lenses. A common question concerns whether medical insurance covers this procedure. Generally, medical insurance does not cover LASIK, as it is typically viewed as an elective vision correction procedure, not a treatment for a disease. This article details insurance coverage for LASIK, including private plans, government programs, medical necessity, and financing options.
Understanding Private Health Insurance Coverage
Private health insurance plans usually categorize LASIK as an elective or cosmetic procedure, and most do not cover its cost. These plans cover medically necessary treatments for illnesses or injuries, not procedures that improve vision without addressing an underlying medical condition. Policies often explicitly state that refractive surgeries like LASIK are not covered.
Most private health insurance policies consider glasses and contact lenses adequate alternatives for vision correction, reinforcing LASIK’s elective designation. Vision insurance plans, distinct from medical insurance, sometimes offer discounts or partial coverage for LASIK. These discounts might reduce the out-of-pocket cost, but full coverage remains rare. Review specific policy documents or contact the insurance provider directly to understand any available benefits or network discounts.
LASIK and Government Health Programs
Government health programs, including Medicare and Medicaid, generally do not cover LASIK. Original Medicare (Part A and Part B) does not cover LASIK, considering it an elective vision correction procedure. Medicare covers eye surgeries only when medically necessary to treat diseases or conditions like cataracts, glaucoma, or diabetic retinopathy, distinct from routine vision correction.
Some Medicare Advantage plans, offered by private companies, might provide additional vision benefits that could include partial LASIK coverage. This coverage is not universal and depends on the specific plan and location. Medicaid coverage for LASIK is also very limited, focusing on medically necessary treatments for severe eye conditions or injuries rather than elective vision correction. Federal regulations require vision care for Medicaid recipients under 21, but for adults, routine vision correction or elective surgeries like LASIK are generally excluded.
Medical Necessity and Coverage Criteria
Medical necessity determines whether eye surgery, including LASIK, receives insurance coverage. Insurance providers, both private and government, may cover eye surgery if it is medically necessary to treat a disease or condition that significantly impairs vision and cannot be effectively corrected by traditional means like glasses or contacts. LASIK for routine nearsightedness, farsightedness, or astigmatism is almost never considered medically necessary.
Examples of conditions that could qualify for coverage include severe refractive errors from injury or previous surgery, or situations where a patient cannot safely wear corrective lenses due to medical issues like severe allergies or deformities. Even then, coverage criteria vary significantly between insurance companies, and a healthcare professional must certify medical necessity. This typically involves a thorough evaluation by an ophthalmologist, followed by a prior authorization request to the insurance provider, which can take several days to weeks for review.
Financing Your LASIK Procedure
For individuals whose insurance does not cover LASIK, several financing options can make the procedure more affordable. Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are popular choices, allowing individuals to use pre-tax dollars for qualified medical expenses, including LASIK. For 2025, the IRS has set contribution limits for FSAs at $3,300, while HSA limits are $4,150 for individuals and $8,300 for families. Using these accounts can result in substantial savings, potentially 20% to 30%, depending on one’s tax situation.
Many LASIK providers offer payment plans and financing options, often with zero-down payment options or promotional periods with 0% interest, typically ranging from 12 to 24 months. These plans may be offered directly by the clinic or through third-party healthcare credit cards like CareCredit. Personal loans or general-purpose credit cards can also be used, though interest rates may vary. The cost of LASIK, which averages around $2,200 to $2,600 per eye, or $4,200 to $5,000 for both eyes, is considered a tax-deductible medical expense by the IRS. Taxpayers who itemize deductions can include LASIK expenses if their total unreimbursed medical expenses exceed 7.5% of their adjusted gross income (AGI).