Does Medicaid Cover LASIK? - Grants for Medical

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 long-term vision correction, though some may eventually need glasses or contacts as they age.

Although it can’t prevent age-related changes, LASIK reshapes the cornea and lets you see better.

Despite all these benefits, LASIK is considered an optional benefit, so Medicaid programs do not usually cover it.

Usually, 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 necessary.

There are instances where physicians prescribe LASIK to correct refractive issues caused by eye injuries or past operations.

LASIK may also be medically necessary for people who can’t wear contacts or glasses due to physical restrictions.

Medicaid does not typically cover the cost of LASIK surgery as it is considered elective and not medically necessary. 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:

1. When an injury causes a refractive issue.

2. When a previous operation causes the refractive issue.

3. When the refractive issue is severe.

4. 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.

Again, if a doctor approves that LASIK is the only option to correct the issue, Medicaid will cover the operation.

In such instances, Medicaid covers expenses like other types of operations.

Note that coverage will depend on the state in which you currently reside. Also, the operation must be done by a physician and in a facility accepting Medicaid coverage.

How Can You Get Medicaid to Cover Your LASIK Operation?

Usually, Medicaid doesn’t cover the expenses of LASIK operations. 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 need to contact your Medicaid provider to determine which vision benefits are considered ‘medically necessary.’

Next, you should contact an eye expert, preferably the one who will conduct the operation, and see if you meet your Medicaid provider’s conditions.

If you often visit an eye expert approved by your insurance provider, they are already familiar with the requirements.

For instance, if you have Medicaid coverage 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.

If you have only Medicaid coverage, Medicaid will cover the cost of the entire procedure if it’s medically necessary.

How Much Does LASIK Surgery Cost without Medicaid Coverage?

The average price of LASIK surgery in the US is typically around $2,000 to $3,000 per eye. This is a massive amount, considering operating on each eye takes less than 10 minutes.

LASIK operations can also cost $4,000 per eye, depending on the clinic.

Beware of hospitals offering meager LASIK prices, such as $500; you’ll most likely find 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?

You may qualify for aid outside Medicaid if you want to get a LASIK operation.

One option is to use your HSA (Health Saving Account) or FSA (Flexible Spending Account) to pay for the operation. These plans cover laser vision correction operations per the RSC (Refractive Surgery Council).

So, depending on your HSA or FSA account amount, you could cover some or all operating expenses.

Another alternative is to consult your eye surgeon for financing LASIK surgery.

Many hospitals offer loans or flexible payment plans that enable patients to spread the cost of their LASIK surgery over time, often interest-free. However, an upfront deposit may be required.

Ask about hidden costs, pre-payment fines or late payment fees, and 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 coverage that includes vision benefits.

Lastly, consider getting vision insurance if you wear spectacles or 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.

Final Thought

Medicaid usually doesn’t pay for LASIK eye surgery because it’s an elective procedure, and cheaper options exist.

However, since Medicaid is funded and controlled by states, coverage may depend on where you live and if the procedure is medically necessary.

You can check the Medicaid website or contact a local agency for more information on LASIK.