Is Lasik Surgery Covered By Medicare
- Is LASIK surgery covered by Medicare? If your health services are covered by Medicare, some vision services are included. Find out if LASIK is one of them.
Medicare does not help beneficiaries pay the cost of LASIK laser eye surgery. Because the LASIK procedure is regarded as a nonessential elective surgery, you may be expected to pay out of pocket for most or all of your costs.
Is Lasik Covered By Private Insurance
Private insurance companies offer a wide range of services for a great variety of customers. Because of this diversity, it’s difficult to generalize about coverage for specific medical procedures. As a rule, private insurance policies do not include elective procedures when a viable alternative to them exists. In the case of LASIK eye surgery, which is most often done to correct nearsightedness, farsightedness and astigmatism, glasses or contact lenses are almost always less expensive alternatives to surgery.
What Is Included In The Cost Of Lasik
The factors in the cost of LASIK eye surgery include:
- Overhead for the eye center
- Post-operative care and the number of follow up appointments needed
- Pre-treatment diagnostic testing
The cost may include the initial LASIK consultation. However, this service is provided for free at most LASIK practices.
The price may not include pre-and post-op visits. If there is a problem that requires additional care, it may cost extra.
Patients considering LASIK should get a written cost estimate that itemizes everything in the offer. Patients should read the fine print and ask about all potential additional fees before going ahead with the procedure.
Conventional LASIK involves using a laser or blade to make a corneal flap. It is typically the most affordable type of laser refractive surgery. In most cases, it also requires the least recovery time.
Typically, only those with straightforward prescriptions and vision correction requirements are eligible for conventional LASIK. Conventional LASIK is the most basic and least expensive of the LASIK procedures.
Generally, farsighted people and those with astigmatism aren’t good candidates for traditional LASIK.
Here are the different types of LASIK surgery available and their average costs per eye:8
- Custom LASIK costs $2,100
- All laser or bladeless LASIK costs $2,119
- LASEK or epi-LASEK costs $2,000
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What Is The Difference Between Elective And Non
Elective medical procedures are loosely defined as those that can be scheduled in advance. This does not mean that a procedure is not necessary, but rather that you have some control over how and when it is performed. Non-elective procedures tend to be more urgent. Medicare commonly defines elective procedures as being extra, unnecessary or highly specialized operations for which a suitable alternative is already included in coverage. In the case of LASIK, routine eye surgery is already included under Part B.
Cataract Surgery And Medicare
Now that you know a little more about Medicare and cataracts that dont require surgery, lets take a look at surgical options.
Cataract surgery is a simple procedure that involves replacing the natural lens in the affected eye with an artificial one. If you have cataracts in both eyes, youll likely have it performed on one eye at a time.
- Eye exams to diagnose serious vision problems
- Pre-surgery eye exams
- One pair of prescription eyeglasses or contact lenses after surgery
- Up to one year of follow-up care
Medicare For Outpatient Services
LASIK is almost always performed on an outpatient basis, usually with the person getting the surgery returning home within hours after the procedure is finished. It is only necessary to go to the hospital after LASIK surgery if there have been complications, which are generally very rare. Because of this, LASIK laser eye surgery is considered an outpatient surgical procedure.
Medicare pays for the outpatient surgeries included in its plans under Part B, the outpatient benefit. Most of the people who have Part B coverage pay a monthly premium and a co-payment for provided services, such as ambulatory surgery, medical office visits and transportation to and from medical facilities. Because LASIK is an elective procedure, and because glasses and contact lenses are considered viable alternatives to LASIK, Medicare Part B does not pay for the procedure.
Unfortunately, Original Medicare also generally doesnt pay for glasses or corrective contact lenses. This can leave many Medicare beneficiaries paying out of pocket for vision services, even if no viable alternative is available to them. Note that Medicare does sometimes pay for limited vision services, such as repair of injuries and other incidental care, but routine vision care is not included as a benefit under Part B.
What Doesnt Medicare Cover For Eye Surgeries
If your eye doctor recommends an outpatient procedure to correct a vision problem such as nearsightedness, farsightedness, and astigmatism, it is not covered by Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage….. As a result, popular LASIK and other corrective eye procedures are not covered.Medicare.gov, Surgery, Accessed November 4, 2021
This is because it is medically unnecessary to perform surgery on your eyes for a condition that can be remedied with eyeglasses. If you want the luxury of not having to wear glasses during everyday life, youre going to have to pay for it.
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How To Get Private Health Insurance For Laser Eye Surgery
So you need to correct your vision, but the health insurance benefits available remain a blur. Its essential to understand what to expect regarding the operation and the associated costs. You may also want to compare the private health insurance plans available to you to find the right cover for your requirements.
When it comes to laser eye surgery, there are limited options available to you. Insurers like HIF and AHM offer members limited cover under Hospital and/or Extras cover for vision-related procedures. Having a good understanding of your condition and the type of treatment you need will generally guide you to the right cover for your requirements.
Does Medicare Cover Eye Exams
If you want to run into your local vision center for a simple exam to get glasses, Medicare wont cover. Youll be 100% responsible for the cost of your prescription eyewear, as well as your routine exam.
If youre in the market for preventive screenings and tests to check for glaucoma or macular degeneration, youre in luck. Medicare will cover preventive screenings to help keep the health of your eyes in check. Not only will Medicare cover the exams for macular degeneration, but theyll include any doctor visits to treat the disease.
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Eye Care Benefits Most Plans Cover
UHC plans often offer comprehensive coverage for traditional vision expenses. For example, UHC employer plans offer covered vision benefits, such as:
- Eye exams.
- Scratch-resistant coating on eyeglass lenses.
- Contact lenses.
With a benefit like this, people could walk into an associated vision provider and go through a comprehensive examination. At the end of this examination, people would understand how well they can see right now and how much lens correction is required in order to deliver crisp vision at all distances.
In Kansas between 2011 and 2012, people with UHC coverage could obtain an exam, a pair of eyeglass lenses, or a set of contact lenses once every 12 months for a $25 copay. This information comes from a benefits summary created by UHC for the Kansas Board of Regents. A table like this is typically provided to people when they enroll in care. It spells out exactly what is covered and what is not.
These benefits typically apply only to work done by providers within the UHC network. According to UHC, that network includes both retail and private practice locations, which seems to give members quite a few treatment options to choose from.
It’s important to note, however, that these covered benefits do not seem to apply to LASIK. In available documents online about coverage UHC offers to people who want LASIK, there are no mentions of covered surgery. The company chooses to deal with this issue in a very different way.
Does Medicare Cover For Lasik Eye Surgery
Medicare Part A and Part B do cover the costs of certain medical eye conditions, if the person requires hospitalization or emergency care. Original Medicare also covers eye doctor consultation and treatments to improve or cure certain chronic eye conditions such as glaucoma and cataracts, if the persons doctor considers the treatment is necessary. However, Lasik eye surgery is not considered medically mandatory and hence it is not covered.
Not just Medicare, most other healthcare insurance also do not cover Lasik eye surgery, unless the persons job requires perfect vision. Athletes and combat fighters sometimes qualify for full coverage. Few insurance companies negotiate reduced rates from lasik surgery providers for their customers.
Is Lasik Covered By Medicare
Unfortunately, Medicare won’t cover the costs of LASIK or any similar laser eye surgery, but some Medicare Advantage plans might.
What is LASIK? If you wear prescription glasses or contact lenses, youve probably considered laser eye surgery as a way to see clearly without specs or contacts. LASIK improves vision for patients with nearsightedness, farsightedness or astigmatism, often providing immediate and long-term improvement with minimal pain or discomfort.
Lets review why LASIK isnt included in your Medicare benefits, how this procedure differs from cataract surgery and the potential costs involved if you elect to have laser eye surgery.
Will Medicare Cover Treatment For Glaucoma
Glaucoma is a disease that damages the optic nerve, potentially resulting in vision loss. Medicare Part B will cover annual glaucoma screenings for those considered high-risk, including diabetics and older Americans with a family history of the disease. African Americans aged 50 and older, and Hispanic individuals aged 65 and over are also considered high-risk. Youll still be responsible for your Part B deductible and 20 percent of the cost of your exam.
Glaucoma treatment is generally covered under Medicare. Outpatient laser surgery falls under Part B, and eye drops to address the condition fall under Medicare Part D. Your out-of-pocket costs associated with your drops will depend on your Part D plans formulary.
Because Medicare Advantage is required to provide the same level of coverage as original Medicare, it does pay for glaucoma screenings and treatment. Medigap, meanwhile, can cover some or all of the costs associated with your glaucoma screening and treatment under Medicare by picking up the tab for your deductibles and coinsurance.
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Will Medicare Pay For Treatment For A Detached Retina
A detached retina can cause permanent vision loss if not treated quickly. Medicare will cover surgery to repair a detached retina, but youll be responsible for your Part B deductible and 20 percent coinsurance, which Medigap can help take care of. Depending on where you have your procedure, a copayment might apply as well. Similarly, Medicare Advantage will pay for the cost of retina surgery to preserve vision.
How Much Does Lasik Eye Surgery Cost Without Insurance
LASIK’s price has remained stable for the past ten years, while other economic factors have risen.
It is estimated that today’s LASIK is approximately 20 to 30 percent less expensive than it was just ten years ago.5
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The average cost of LASIK surgery in the United States is approximately $2,200 per eye or $4,400 for both.
There may be additional out-of-pocket costs after LASIK surgery. Patients may need to buy artificial tears for a couple of months post-surgery. Artificial tears are not covered by insurance.
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Lasik Discounts Are Available
Rather than offering LASIK as a covered benefit or a benefit with a copayment that can be applied toward a medical deductible, UHC offers members a discount on LASIK surgery.
This means that people with UHC coverage can get LASIK surgery through their connection with UHC. They can pay a little less for surgery than they might pay if they came to the office on their own with no insurance at all.
But the payments members make for LASIK are paid out of their own pockets. Those payments do not apply toward any kind of UHC deductible.
The discounts available can be generous. According to UHC, one featured provider can give UHC members free LASIK screening exams, which are more involved than a standard vision exam. This provider can offer surgeries for as little as $695 per eye, with financing options available. There are over 500 locations that offer this benefit to UHC members.
Often, UHC offers two sets of pricing: one for a preferred provider and one for another provider. There is no such distinction with this particular program. UHC members must go to this specific provider to get the discounts and achieve savings with their coverage.
Medicare Advantage To The Rescue
That said, some Medicare Advantage plans provide coverage for LASIK eye surgery. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits. However, out-of-pocket costs will vary depending on the plan provided by the plan providers.
But how can you get Medicare Part C to cover your LASIK eye surgery, you may ask? Well, here are some ways Medicare Part C may provide coverage for your LASIK eye surgery:
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Medicare And Lasik Eye Surgery
May 30th, 2017 Medicare
Lasik eye surgery is a laser procedure, performed by an ophthalmologist in order to improve eye vision by reshaping the eyes cornea which basically means a person can get rid off eye spectacles or contact lenses permanently after the surgery. The cost for the Lasik eye surgery include surgeon fee, the costs of the vision center and cost for the care before and after the eye surgery. Although, Lasik cost will vary for each person depending on his eye condition and requirement.
Does Medicare Cover Laser Cataract Surgery
Cataracts are unfortunately a very common part of getting older. In fact, over half of Americans will develop cataracts, or need cataract surgery by the time theyre 80.
When they first form, you probably wont even notice them. However, over time, they will start to affect your vision. It may get to the point where they affect your daily activities. If you dont treat cataracts, they can lead to vision loss. So its better to do something about them sooner rather than later.
The treatment for getting rid of cataracts is surgery. While sometimes a surgeon will use surgical tools for this surgery, using lasers is another option.
So a common question many people have is, Does Medicare cover Laser Cataract Surgery? In this article, we answer this question in clear, plain English. You will also find the average costs of laser cataract surgery, as well as other helpful info.
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How To Get Insurance To Pay For Lasik
Its not impossible for insurance to pay for LASIK surgery. If the procedure can be proven to be medically necessary rather than elective, your vision insurance provider may help cover the cost.
For this to happen, youll first need to speak with your particular insurance carrier and find out what falls under their criteria for medically necessary. You should then speak with your eye doctor and see if you meet any of the criteria listed by your insurance provider.
Many times, if you visit an eye doctor within your insurance network, theyre already familiar with the requirements. For instance, if you have insurance through EyeMed and visit an EyeMed-approved doctor, the doctor will likely be knowledgeable about what EyeMed will and wont cover. Its also common for insurance carriers to offer discounts for using certain in-network surgeons for the procedure.
Individuals who are unable to claim LASIK as a medically necessary procedure can still utilize their flexible spending account or health savings account to help with some or all expenses. FSAs and HSAs are tax-exempt accounts that allow you to save up and pay for medical needs and procedures.
LASIK qualifies as a covered procedure for FSA and HSA, so if youre looking for a way to cushion the blow of the full cost of surgery, dipping into these accounts can definitely help.
What Does Cataract Surgery Cost With Medicare
According to Medicare.gov, having cataract surgery at an ambulatory surgical center costs about $1,789 . Medicare pays $1,431 of that total, which means the patient pays $357.
Having cataract surgery with a hospitals outpatient department, on the other hand, costs $2,829 . Medicare pays $2,263 of that total, so the patient pays $565. These estimates vary based on where you live and the complexity of your cataracts.
The cost of cataract surgery with Medicare Advantage varies widely based on your specific plan. Contact a customer service representative with your provider to discuss what you can expect to pay before undergoing the procedure.
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Medicare Advantage Plans May Cover Lasik And Other Vision Care
Medicare Advantage is a privately-sold alternative to Original Medicare that combines the same hospital and medical benefits into one plan.
Most Medicare Advantage plans provide additional benefits, including vision care.
A Medicare Advantage plan that offers vision benefits may cover routine vision care, such as:
- Corrective glasses lenses
- Contact lenses
- Routine eye exams
You are likely eligible for Medicare Advantage if youre enrolled in Medicare Part A and Part B and live in a Medicare Advantage plans service area.
Not all Medicare Advantage plans offer vision benefits, and the vision benefits included in your plan may not include coverage for LASIK surgery. Check with your Medicare Advantage plan provider for more information.