Does Medicaid Cover Lasik? – Overview
Myopia and other refractive problems can make it hard to read or work. You might also experience migraines, eye strain, and blurry vision. These problems affect persons in all age groups, from kids and adolescents to adults.
One way to correct refractive problems is to get a Lasik operation. Unlike contacts and spectacles, Lasik offers patients permanent results. Although it can’t prevent age-related changes, Lasik reshapes the cornea and enables you to see better.
Despite all these benefits, Lasik is considered an optional benefit, and as a result, it’s not usually covered by Medicaid programs. Normally, Medicaid covers routine eye exams, eyewear frames, corrective lenses, and low vision aids.
Medicaid can also cover prosthetics, contact lenses, and medication for eye problems when deemed medically necessary. There are instances where physicians prescribe Lasik to correct refractive issues caused by injuries to the eyes or past operations.
Lasik may also be medically necessary for people who can’t wear contacts or glasses due to physical restrictions. In such instances, Medicaid will cover the cost of the LASIK operation. The extent of coverage varies from state to state, so ensure you check local regulations.
When Does Medicaid Cover Lasik Surgery?
Medicaid will pay for Lasik operations for refractive issues under the following circumstances:
- When an injury causes the refractive issue.
- When a previous operation causes the refractive issue.
- When the refractive issue is severe.
- When a patient cannot wear contacts or glasses because of physical restrictions.
For instance, if a traumatic injury requires an operation to correct the problem and Lasik is the only option, a doctor can approve the operation as medically necessary.
Another instance is when an initial Lasik operation is done for cosmetic purposes, and it’s now causing vision problems. Again, if a doctor approves that Lasik is the only option to correct the issue, the operation will be covered by Medicaid.
In such instances, Medicaid covers expenses in the same way it does for other types of operations. Note that coverage will depend on the state you currently reside in. Also, the operation must be done by a physician and in a facility that accepts Medicaid cover.
How Can You Get Medicaid to Pay for Your Lasik Operation?
Usually, Medicaid doesn’t cover the expenses of Lasik operations, as illustrated above. But if the operation can be proven to be medically necessary rather than optional, then Medicaid will help cover the expenses.
For this to happen, you’ll first need to get in touch with your Medicaid provider and find out which vision benefits fall under ‘medically necessary.’ Next, you should contact an eye expert, preferably the same one that will conduct the operation, and see if you meet any of the conditions set by your Medicaid provider.
Many times, if you visit an eye expert approved by your insurance provider, they are already familiar with the requirements. For instance, if you have Medicaid cover and see a Medicaid-approved doctor, the doctor will most likely know what Medicaid won’t cover.
Suppose you have dual eligibility (Medicaid and Medicare)? In that case, Original Medicare (Part A & B) will cover a portion of the expenses, and Medicaid will cover the subsequent copayments, deductibles, and coinsurance. But, if you only have Medicaid cover, then Medicaid will cover the cost of the entire procedure if it’s medically necessary.
How Much Does a Lasik Operation Cost without Medicaid?
The average price of Lasik operations in the US is about $2200 per eye. This is a massive amount considering it takes less than 10 minutes to operate on each eye. Lasik operations can also go up to $4000 per eye, depending on the clinic. Beware of hospitals with extremely low prices for Lasik, such as $500; most likely, you’ll find that there are hidden costs later.
The price of a Lasik operation depends on several factors, such as the severity of the refractive issue, equipment, operation facility, and technology deployed. Therefore, you must conduct due diligence before committing to a surgeon or a clinic.
Many insurance providers such as Medicaid have a list of recommended eye experts that meet a specific threshold of honesty and credibility. Taking your time to find the right surgeon is a small price to pay for a smooth and lasting Lasik eye surgery.
Do You Have Coverage Options Other Than Medicaid for LASIK?
If you decide you want to get a Lasik operation, you may qualify for aid outside Medicaid.
One option is to use your HSA (Health Saving Account) or FSA (Flexible Spending Account) to pay for the operation. Both of these plans cover laser vision correction operations as per the RSC (Refractive Surgery Council). So depending on the amount in your HSA or FSA account, you could cover some or all of the operation expenses.
Another alternative is to consult your eye surgeon on Lasik surgery financing. Currently, a lot of hospitals have loans or flexible payment plans that enable patients to spread the cost of their Lasik operation over a couple of months or years. Some of these plans don’t have interest, but you’ll be required to make an upfront deposit. Ensure you ask about hidden costs, pre-payment fines or late payment fees, and any other expenses.
Your employer could also be of assistance. Nowadays, many firms are offering their employees discounts for eye operations, dental surgery, and other treatments that Medicaid or Medicare does not cover. In addition, large enterprises also provide their staff with private medical covers that include vision benefits.
Lastly, consider getting vision insurance if you wear spectacles or you have a chronic eye condition. The RSC (Refractive Surgery Council) says that some vision insurance providers offer discounts of up to 50% on Lasik or refractive eye operations.
Medicaid usually doesn’t pay for Lasik eye surgery because it’s an elective procedure, and there are cheaper options out there. However, since Medicaid is funded and controlled by states, coverage may depend on where you live and if the procedure is medically necessary. So you can check the Medicaid website or reach out to a local agency for more information on Lasik.