Does Medicare Pay for LASIK Eye Surgery?

Medicare is a federal health insurance program primarily designed for individuals aged 65 or older, younger people with certain disabilities, and those with End-Stage Renal Disease. It helps cover healthcare costs, but its coverage for vision services, particularly elective procedures like LASIK eye surgery, often confuses beneficiaries. Understanding Medicare’s coverage policies is important for those seeking vision improvement.

Medicare’s General Vision Coverage

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), covers medically necessary eye care. It covers services and treatments for eye diseases, injuries, or conditions requiring medical intervention. For example, Medicare Part B may cover diagnostic tests and treatments for serious eye problems.

However, Original Medicare does not cover routine vision care. This exclusion often includes annual eye exams, eyeglasses, or contact lenses for general vision correction. Medicare Advantage Plans (Part C), offered by private insurance companies, may provide additional benefits, including routine vision care. These plans vary significantly, so individuals must review details to understand their vision benefits.

LASIK as a Refractive Procedure

LASIK (Laser-Assisted In Situ Keratomileusis) is a surgical procedure designed to reshape the cornea. This reshaping corrects refractive errors such as nearsightedness, farsightedness, and astigmatism, reducing or eliminating the need for glasses or contact lenses. LASIK is considered an elective procedure because its primary purpose is to enhance vision and reduce reliance on corrective lenses, not to treat a disease or injury.

Because LASIK is not deemed medically necessary to treat a specific eye condition, Original Medicare does not cover its cost. While some Medicare Advantage plans may offer coverage, it is not guaranteed and often limited. The decision to undergo LASIK is made to improve quality of life and convenience, not to restore vision lost due to illness.

Situations Where Eye Surgery May Be Covered

While LASIK is excluded, Medicare covers other eye surgeries and treatments when medically necessary. This includes procedures for conditions threatening eye health or vision. For example, Medicare Part B covers cataract surgery, involving removal of a clouded lens and often implanting an intraocular lens.

Treatments for eye diseases like glaucoma, macular degeneration, and diabetic retinopathy are also covered by Medicare. Coverage extends to diagnostic tests, medical treatments, and surgical interventions to manage these conditions. The distinction lies in medical necessity; these procedures address underlying health issues, unlike LASIK, which is for vision enhancement.

Paying for LASIK

Since Medicare does not cover LASIK, the cost is an out-of-pocket expense. The national average cost for LASIK ranges from $1,500 to $4,000 per eye, depending on prescription complexity and technology used. This also reflects variations in geographic location and surgeon expertise.

Some private vision insurance plans, separate from Medicare, may offer discounts or partial coverage. Benefits vary widely by plan and provider. Many LASIK providers also offer financing options, allowing patients to pay through installment plans. Additionally, individuals may utilize Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) to pay for LASIK with pre-tax funds, offering potential cost savings.