Does Medicare Cover Laser Eye Surgery?

Medicare, a federal health insurance program, primarily serves individuals aged 65 or older, along with certain younger people with disabilities or specific medical conditions. Many beneficiaries wonder if Medicare covers laser eye surgery. Coverage depends on whether the procedure is elective or medically necessary for treating an eye disease or condition.

General Medicare Eye Coverage

Original Medicare (Part A and Part B) covers various healthcare services. For eye care, Medicare Part B does not cover routine eye exams, eyeglasses, or contact lenses for vision correction, as these are considered elective or cosmetic. However, Part B does cover diagnostic and treatment services for specific eye diseases and conditions that are medically necessary, such as glaucoma, cataracts, and macular degeneration.

Medicare and Refractive Laser Eye Surgery

Refractive laser eye surgeries, such as LASIK and PRK, are designed to correct vision and reduce reliance on glasses or contact lenses. These procedures address common refractive errors like nearsightedness, farsightedness, and astigmatism. Original Medicare does not cover LASIK or PRK, as they are considered elective procedures for vision improvement. Medicare views these surgeries as not medically necessary for treating a disease or injury, given that alternative vision correction methods like eyeglasses or contact lenses are available.

Medicare and Medically Necessary Laser Eye Procedures

While elective refractive surgeries are not covered, Medicare does cover certain laser eye procedures when medically necessary to treat specific eye diseases or conditions. Coverage is determined by medical necessity to treat an underlying illness, not solely for vision correction.

Cataract Surgery

Cataract surgery, which often utilizes laser technology, is covered by Medicare Part B when medically necessary to remove a clouded lens affecting vision. This coverage extends to both traditional and laser-assisted cataract removal, including the implantation of a conventional intraocular lens. However, if a beneficiary chooses advanced lens implants, such as multifocal or toric intraocular lenses, or other features beyond the standard, Medicare may not cover the additional costs associated with these premium options.

Glaucoma Treatment

Laser procedures for glaucoma, a condition characterized by damage to the optic nerve often due to high eye pressure, are covered by Medicare Part B. These treatments, such as Selective Laser Trabeculoplasty (SLT), Argon Laser Trabeculoplasty (ALT), and Laser Peripheral Iridotomy (LPI), aim to manage intraocular pressure and prevent further vision loss.

Diabetic Retinopathy

Diabetic retinopathy, a complication of diabetes that damages blood vessels in the retina, can also be treated with laser photocoagulation. Medicare Part B covers this laser treatment when it is medically necessary to seal leaking blood vessels or destroy abnormal ones, thereby preventing vision loss caused by the condition. This treatment is crucial for stabilizing vision and slowing the progression of the disease.

Financial Aspects of Laser Eye Procedures

Financial responsibilities for laser eye procedures vary based on Medicare coverage. For procedures not covered by Original Medicare, such as LASIK, the patient is responsible for 100% of the cost. The expense for these elective surgeries can range from approximately $2,000 to $3,000 per eye.

For medically necessary laser eye procedures covered by Medicare Part B, beneficiaries pay an annual deductible. In 2025, the Medicare Part B annual deductible is $257. After meeting this deductible, beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount, with Medicare covering 80%. This cost-sharing applies to covered outpatient services, including laser eye treatments for conditions like cataracts, glaucoma, and diabetic retinopathy.

Medicare Advantage Plans (Part C), offered by private insurance companies, are an alternative to Original Medicare and must cover at least all services that Original Medicare covers. Many Medicare Advantage plans also provide additional benefits, such as routine vision care, including eye exams and allowances for eyeglasses or contacts, which are not covered by Original Medicare. Some Medicare Advantage plans might even offer partial coverage or discounts for elective procedures like LASIK, though this varies by plan. Additionally, Medigap (Medicare Supplement Insurance) plans can help cover some of the out-of-pocket costs, such as the 20% coinsurance, for services covered by Original Medicare. However, Medigap plans do not cover services that Original Medicare does not cover, like elective laser eye surgery or routine vision care.