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Does insurance cover LASIK eye surgery?

vision insurance form coverage for lasik

Vision insurance, in a nutshell, is meant to make our lives easier. But for those interested in having LASIK eye surgery, vision insurance may not offer much help.

Nearly all vision insurance providers view LASIK as an elective surgery, which disqualifies it from being covered. However, each insurance group provides certain incentives that can relieve the sting of a LASIK surgical bill.

VSP LASIK coverage

While VSP vision insurance doesn’t claim to cover LASIK surgery, the insurance carrier does offer a VSP Laser VisionCare Program. This program is available to most VSP members and offers benefits that may help with the cost of LASIK.

Want to learn more? If you're a current VSP member or interested in becoming one, you can log in or register at vsp.com to get more information and find out if you qualify for laser vision benefits.

In addition to their laser vision benefits, VSP often partners with LASIK centers to provide discounts on services. Also, using a VSP in-network eye doctor for surgery can help reduce your out-of-pocket cost.

Tricare LASIK coverage

Tricare, the health care program for military service members and their families, does not cover LASIK surgery unless deemed medically necessary by a Tricare-approved physician. Coverage also varies based on certain details and circumstances, so to get proper perspective on what your coverage includes, it’s best to contact a Tricare agent.

Medicare and Medicaid LASIK coverage

LASIK is not covered by Medicare or Medicaid, as it is considered an elective procedure. However, there are some cases where LASIK is classified as medically necessary and insurance coverage may be possible.

For instance, the insurance duo may cover refractive error LASIK in the following situations:

  • Refractive errors are deemed severe by a licensed professional.

  • Refractive errors were caused by an injury or previous surgical procedure.

  • Physical limitation prevents the patient from wearing glasses or contact lenses.

So, if you’ve had vision surgery before (elective or otherwise) and the surgery created problems for your vision that can only be fixed with LASIK, the cost would likely be covered in the same way another medically necessary procedure would be covered. However, the eye surgeon and location where LASIK is performed must accept Medicare and/or Medicaid cases.

It’s important to note that Medicaid is funded and regulated by the state, which means coverage and other important details can vary depending on where you live. Make sure to check the Medicaid website for your particular state or reach out to a local representative for more information.

SEE RELATED: Does Medicare cover eye exams?

How to get insurance to pay for LASIK

It’s 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, you’ll 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 (preferably the same one that plans to perform the surgery) 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, they’re 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 won’t cover. It’s 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 (FSA) or health savings account (HSA) 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 you’re looking for a way to cushion the blow of the full cost of surgery, dipping into these accounts can definitely help.

Cost of LASIK without insurance

The average cost of LASIK in 2020 is $2,133 per eye — a hefty sum, considering each eye takes less than 10 minutes during the procedure. However, the price of the surgery depends on several variables, such as location, equipment and technology used, and the severity of your refractive error.

It's important to do thorough research before committing to a LASIK center or surgeon. Many vision insurance providers have a list of recommended eye doctors that meet a certain threshold of credibility and trustworthiness.

Taking the time to find a practice and surgeon that puts you at ease is a small price to pay for a smooth and successful LASIK experience.

SEE RELATED: PRK cost

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