Does Medicare Cover LASIK Eye Surgery?

Medicare, the federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease, helps Americans manage healthcare costs. As people age, vision changes are common, leading many to seek clarity on what eye care services their Medicare benefits might cover. This often raises questions about specific procedures, such as LASIK eye surgery.

Medicare’s Stance on LASIK

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), does not cover LASIK eye surgery. LASIK is typically considered an elective procedure for correcting refractive errors like nearsightedness, farsightedness, or astigmatism, rather than treating a medical disease or injury. Medicare’s coverage focuses on services deemed medically necessary for the diagnosis or treatment of illness or injury. Since vision correction can often be achieved through less invasive means like eyeglasses or contact lenses, LASIK falls outside the scope of Original Medicare benefits.

While Original Medicare does not cover LASIK, some Medicare Advantage Plans (Part C) might offer limited vision benefits that could include coverage for the procedure. These plans are offered by private insurance companies approved by Medicare and often bundle Part A, Part B, and Part D (prescription drug coverage), along with additional benefits. However, coverage for elective procedures like LASIK under Medicare Advantage plans varies significantly by plan and location, and even if covered, there may still be substantial out-of-pocket costs.

Medicare Coverage for Other Eye Conditions

While LASIK is not covered, Original Medicare provides coverage for a range of medically necessary eye care services and treatments. Medicare Part B covers diagnostic tests and treatments for eye diseases and injuries. For instance, Medicare Part B covers medically necessary services for conditions such as glaucoma, including annual screenings for individuals at high risk, and treatments like eye drops, laser therapies, and surgery.

Medicare Part B also covers diagnostic tests and treatments for age-related macular degeneration (AMD), a leading cause of vision loss in older adults. This can include anti-vascular endothelial growth factor (anti-VEGF) injections, common treatments for wet AMD, with beneficiaries paying 20% of the Medicare-approved amount after meeting their Part B deductible. For individuals with diabetes, Medicare Part B covers one annual eye exam for diabetic retinopathy, a condition that can damage the blood vessels in the eyes and lead to vision loss. Treatment for eye injuries is also covered by Medicare Part B. Original Medicare does not cover routine eye exams for eyeglasses or contact lenses, nor the cost of the eyewear itself.

Comparing LASIK with Medically Necessary Eye Surgery

The distinction between LASIK and other eye surgeries Medicare covers, such as cataract surgery, is often misunderstood. Cataract surgery removes a cloudy natural lens from the eye and replaces it with an artificial intraocular lens (IOL), treating a medical condition that impairs vision. Because cataracts are a medical disease that can lead to significant vision impairment, cataract surgery is deemed medically necessary by Medicare.

Medicare Part B covers 80% of the Medicare-approved amount for cataract surgery, including the removal of the cataract and the implantation of a standard intraocular lens. This coverage extends to pre-operative and post-operative exams, and includes one pair of prescription eyeglasses or contact lenses after the surgery. In contrast, LASIK reshapes the cornea to correct refractive errors, which is an elective enhancement of vision rather than the treatment of a disease. The fundamental difference lies in the purpose: cataract surgery addresses a disease, while LASIK addresses a refractive condition that can often be managed with corrective lenses.

Financing LASIK and Vision Care Costs

Since Original Medicare does not cover LASIK, individuals considering the procedure often explore financing options. The cost of LASIK can range from $2,000 to $3,000 per eye, depending on factors like the surgeon’s expertise and technology used. Out-of-pocket payment is often the most straightforward method.

Many vision centers and clinics offer financing plans, sometimes with interest-free periods, allowing patients to spread payments over several months or years. These plans are typically subject to credit approval. Another financing option involves utilizing Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), if eligible. These accounts allow individuals to set aside pre-tax income for qualified medical expenses, including LASIK surgery, offering a tax-advantaged way to pay.

Private vision insurance plans, separate from standard health insurance, or specific vision benefits offered by some Medicare Advantage plans, may cover routine eye care services like exams, eyeglasses, or contact lenses. However, these plans rarely cover elective procedures such as LASIK, though some Medicare Advantage plans may offer limited partial coverage. Individuals should thoroughly review their plan documents or contact their insurance provider to understand the specific benefits and limitations related to vision correction surgery.