How To Get LASIK Under Medicare
For a great many people, including seniors, having to wear corrective lenses can be a pain. Contact lenses can be somewhat of a solution, but require constant care. Eyeglasses are easy to use, but can easily be misplaced or broken – which often is a problem for seniors.
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A more modern and hi-tech solution for correcting vision is laser-assisted in situ keratomileusis – more commonly known as LASIK. This procedure involves using a special surgical laser to reshape your eye’s lenses to correct your vision. It is sort of like having permanent and natural contacts. For seniors who are in general good health, they can usually get a LASIK treatment with a high success rate and low incidence of adverse effects.
However, LASIK is usually an expensive procedure, costing around $2,000 per eye. Therefore it’s no surprise that seniors look to Medicare to help them pay for this. While Part B of Medicare does cover many types of outpatient procedures and treatments, LASIK is usually not covered, as will be discussed below. The good news is that many Medicare Advantage plans (Part C) do provide some sort of coverage for LASIK, as will also be discussed below.
Part B Medicare
This is the part of Medicare that covers certain procedures and treatments as an outpatient. Part B is under what is called “original Medicare”. While being very helpful, it is notorious for not covering preventive care, especially in terms of vision, hearing and dental. Part B will provide coverage for only what is deemed to be a “medical necessity”. Normal LASIK to correct vision is not considered a medical necessity, as corrective lenses can be used instead.
But there is no universal list of what can be considered medically necessary. The U.S. Secretary of Health and Human Services sets the process by which that determination is made, and what is deemed necessary and what is not can change over time. This vagueness could help you in some cases, as some medical conditions are best treated with LASIK surgery. For example, a traumatic injury, that requires surgery to preserve the person’s eye, and LASIK is the best way to help that person recover. In a case like this, LASIK is not used to amend vision to help the person eliminate contacts or glasses. It is a surgery to help preserve someone’s eye health and vision. This is the sort of case that could be considered a medical necessity, and it could, in theory, be covered by Medicare.
Medicare Advantage
In addition to enrolling in a standard Medicare plan, you can enroll in a Medicare Advantage Plan (sometimes called Medicare Part C). These plans enhance original Medicare and were established to fill some gaps in Part B and other coverage. Medicare Advantage plans are sold through many private insurance companies, but these plans are approved and regulated by Medicare. These plans must cover the same coverage as original Medicare, but usually provide extra coverage that regular Medicare does not offer. Sometimes, these extra coverages include LASIK for some people.
Please note that you must enroll in and pay for these plans and these plans are subject to limited enrollment periods, so you cannot join them at any time. You may need to wait for the next such period to join. There are many dozens of such Medicare Advantage plans available, and they vary based on your location, health condition and types of coverage desired. A couple of examples of Medicare Advantage plans that provide some type of Lasik coverage are listed below.
Example Plans
Blue Cross Blue Shield
Many BCBS Medicare Advantage plans will cover LASIK for patients who:
• Have been through cataract surgery or corneal transplant.
• Have a difference of more than 3 diopters between their eyes.
• Struggle to see clearly in a way that is not correctable with glasses or contacts.
All three of these conditions must apply in order for the surgery to be covered.
United Healthcare
Their Medicare Advantage plans cover LASIK to fix astigmatism that was caused as a side effect of a prior surgery.
Assistance in Getting Coverage
When you purchase insurance, including Medicare Advantage, you are given information about what is and what is not included. You can look through that information and determine whether or not LASIK seems to apply in your specific situation. You can also ask your doctor to submit a preauthorization form to your insurance company, detailing why LASIK is right for you. Your doctor can attach your medical records to that request to give the insurance company the information they need to make a proper decision. You should hear back about whether or not you will be responsible for the cost.
Some surgeons also have financial aid advisors that can help you understand your benefits, submit appropriate paperwork, and more to see if insurance will cover the cost of care. Some will charge a fee for that work while others do not. If you cannot make sense of insurance on your own, this can be an excellent way to get the answers you need.
