Does Medicaid Cover Lasik?

Does Medicaid Cover Lasik

Laser-Assisted In Situ Keratomileusis, or LASIK, is a type of laser eye surgery that helps correct problems with refractive vision.

Examples of vision problems that can be corrected by LASIK include nearsightedness, farsightedness, astigmatism, and presbyopia. Many people choose to have LASIK surgery so that they don’t have to wear glasses or contact lenses anymore, which can be helpful in day-to-day life.

According to the CDC, 12 million people ages 40 and older in the U.S. have a vision impairment. However, in most cases, LASIK surgery is considered cosmetic and elective, so it is rarely covered by health insurance, including Medicaid and Medicare. However, there are some situations when you may get LASIK coverage through Medicaid. Read on to learn more.

Medicaid coverage for LASIK surgery

Medicaid is a federal and state program that helps cover healthcare costs for people who have limited income and resources and meet other requirements, which vary by state. It also offers benefits for services not covered by Original Medicare. However, in most cases, LASIK eye surgery is not covered.

The cost of vision care covered by Medicaid depends on the state where you live and the restrictions/regulations your state imposes. It also depends on whether the procedure is considered “medically necessary” to treat:

  • An illness
  • An injury
  • A specific condition
  • A disease
  • Symptoms of a disease

When LASIK is considered an elective procedure, it’s not covered. But if the procedure is “medically necessary,” it may be. LASIK is considered medically necessary if the refractive errors are:

  • The result of an injury
  • The result of a previous surgery
  • Severe

It may also be covered if you can’t wear glasses or contacts due to a physical limitation.

In addition to being deemed medically necessary, the LASIK surgery must also be performed in a facility and by a healthcare provider that accepts Medicaid assignment.

Talk to your eye doctor or contact Medicaid to learn more about requirements in your state, or options for LASIK or other vision correction options.

How much does LASIK cost?

In the U.S., LASIK surgery typically costs between $1,000 and $3,000 per eye, depending on where you live and who you choose to do the surgery.

If your surgery is covered and you only have Medicaid coverage, Medicaid would cover the cost of the procedure (assuming your state's Medicaid program covers LASIK). Or, if you’re dual eligible and have Medicaid and Medicare coverage, Medicare would pay a portion of the cost and Medicaid would cover remaining deductibles, coinsurance, and copays that apply. However, Medicare would only pay for the procedure if your doctor claimed LASIK surgery was medically necessary.

If your LASIK surgery is not covered by Medicaid, ask your surgeon about LASIK financing. They may offer payment plans or loans that allow you to spread the cost of the surgery over months or years, paying it off over time. You can also use a Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for LASIK surgery.

Please note that, while you can make deductions from an HSA after you sign up for Medicare, you cannot continue making contributions to your account.

Related readingRules for a Health Savings Account if You Have Medicare

Medicaid vision coverage

Because coverage can vary by state, contact your state’s Medicaid office to learn about your specific coverage. However, most Medicaid programs cover:

  • Necessary eye care, including treatment for eye injuries, conditions, diseases, or symptoms of illness
  • Eye exams deemed to be medically necessary

Some state programs also cover a pair of eyeglasses and/or contact lenses after an eye exam, though again, it must be necessary to correct vision problems due to an accident or disease, or otherwise deemed medically necessary.

Some eye surgeries are also covered when they are performed by an ophthalmologist, such as procedures for cataracts or glaucoma. Certain medications for eye diseases may also be covered.

How is LASIK performed?

There are a number of parts of your eye, including the cornea, pupil, lens, and retina. The cornea helps focus light to create an image on the retina, like the lens of a camera focuses to create an image. For most people, the shape of the cornea isn’t perfect, so the image “projected” on the retina is blurry or out-of-focus. This is called a refractive error and it’s what is fixed during LASIK surgery.

LASIK surgery is typically completed in 30 minutes or less. Numbing drops are placed in your eye, and an instrument is used to hold your eyelids open. A flap is cut in the stromal layer, which is the middle of the cornea, and the flap is folded back to give your doctor access to the cornea. Then, a laser is used to reshape the cornea by removing tiny amounts of tissue, reshaping the cornea, and changing its focusing power. The flap is then put back in place and will heal over time.

After the surgery, you’ll likely have blurred vision and may experience a little pain, itching, or burning. Your doctor will likely prescribe pain medication and/or eyedrops to help you feel more comfortable. After two to three months, your eye will completely heal, and your vision will be improved permanently. More than eight out of 10 people who have LASIK no longer need their glasses or contacts.

Additional Resources

Florida native Eric Ruge lives by one rule: Do the right thing. His goal as a Medicare agent is helping people find the right Medicare coverage for their unique medical needs and budget. He believes everyone deserves the peace of mind they get knowing they made the right decision about their Medicare coverage. When he's not working, Eric enjoys spending time with family and friends, watching Tampa sports, and playing the occasional round of golf.


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