LASIK stands for Laser-Assisted In Situ Keratomileusis. It is a type of laser or refractive eye surgery. The purpose of LASIK eye surgery is to correct problems with refractive vision. Common refractive errors such as nearsightedness, farsightedness, astigmatism, and presbyopia, happen when the shape of the eye inhibits the light from focusing normally on the retina.
The most common reason people choose to have LASIK eye surgery is so they will no longer have to wear glasses or contact lenses to correct vision problems. Because this is considered cosmetic, or elective surgery, Medicare or Medicaid does not offer coverage for the procedure.
However, if your health care provider or ophthalmologist has suggested LASIK eye surgery as a medically necessary option, you may have coverage through Medicaid services or Medicare.
Medicaid Coverage for LASIK Eye Surgery
Medicaid services pay for some tests, procedures, and services that Original Medicare insurance does not cover. If you have dual eligibility and get benefits from Medicaid as well as Medicare, you may have additional coverage for some vision health care. Medicaid also assists in paying for Medicare deductibles, copayments and coinsurance.
Medicaid’s coverage for the cost of vision care depends on the restrictions and regulations of the state you live in and whether the procedure is medically necessary to treat an illness, injury, a specific condition, a disease, or symptoms of a disease.
Neither Medicare nor Medicaid pay for elective eye surgery like LASIK surgery, but there are instances when LASIK surgery can be certified as medically necessary. When this is true and you have dual eligibility, Original Medicare covers a portion of the cost and Medicaid helps cover the deductibles, coinsurance, and copayments that apply. If you only have coverage with Medicaid, they cover the cost of the medically necessary procedure.
Medicare and Medicaid pay for LASIK eye surgery for refractive errors in the following instances:
• When the refractive errors are the result of injury.
• When the errors are the result of a previous surgery.
• When the refractive errors are severe.
• If the patient cannot wear glasses or contact lenses because of physical
limitation.
Here are two examples of when LASIK surgery may be covered by Medicare or Medicaid:
If a traumatic injury requires surgery to save the vision of an eye and LASIK surgery is the only option, a physician can certify it as medically necessary.
Another example is when an initial LASIK surgery, done for cosmetic reasons, has created a vision problem. If the physician certifies that LASIK surgery is the only remedy, it is medically necessary and covered by Medicare or Medicaid.
In cases like these, Medicare or Medicaid cover the costs in the same way they cover other types of surgical procedures.
Because Medicaid is a state regulated program, coverage depends on the regulations of your state of residence. The surgery must also be performed in a facility and by a health care provider that accept Medicaid assignment.
The average cost of LASIK surgery in the United States runs between $1,000.00 and $3,000.00 per eye. The cost depends on where you live and who does your surgery. If your physician or ophthalmologist recommends LASIK eye surgery for a medically necessary reason, it is important to know whether Medicaid Services in your state cover the cost of this procedure. You can get more information about coverage from your health care providers or your local Medicaid or Medicare office.
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