Last Updated on February 27, 2022 by Anne-Sophie Reinhardt
Many Americans always wonder whether Medicaid covers Lasik.
Unfortunately, lasik, despite all its benefits, is not covered by Medicaid programs. Medicaid covers typically routine eye exams, corrective lenses, prescription glasses, and low vision aids.
Myopia and other refractive issues can make it difficult to read and work. Other symptoms include blurry vision, eye strain, migraines, and eye strain. These issues can affect anyone, regardless of age.
A Lasik procedure is one way to correct refractive issues. Lasik is permanent, unlike contacts lenses and glasses. However, Lasik can not prevent the effects of ageing, but it can reshape your cornea and allow you to see better.
Medicaid will cover the cost of prosthetics, contact lenses and medication for eye conditions when they are necessary. Lasik may be required for those who cannot wear glasses or contacts due to medical reasons. Medicaid will pay for the cost of LASIK in these cases. You should check the local regulations to determine if your state has different coverage.
In which case Medicaid Covers Lasik Surgery?
In the following situations, Medicaid covers Lasik procedures for refractive problems:
- An injury is the cause.
- Caused by an operation in the past.
- The refractive problem is serious.
- A patient is unable to wear glasses or contacts because of physical limitations.
If a traumatic injury is severe enough that the patient needs Lasik to fix it, a doctor may approve the procedure as necessary. A Lasik procedure performed initially for cosmetic reasons can now be causing vision problems.
If a doctor agrees that Lasik is the best option, Medicaid will cover the cost. Medicaid will cover expenses for such cases in the same manner as it covers other types of operations.
Coverage will vary depending on where you live. The operation must be performed by a doctor and in a facility that is covered under Medicaid.
How To Get Medicaid to Pay for Your Lasik Operation?
As shown above, Medicaid usually doesn’t pay for Lasik procedures. Medicaid will cover expenses if the operation is medically necessary and not an option. To make this happen, first, contact your Medicaid provider to find out what vision benefits are “medically necessary”.
Next, contact an eye specialist, preferably the same one who will perform the operation. This will help you determine if you have met any conditions as set forth by your Medicaid provider. Many times, an approved eye specialist will be able to help you meet the requirements.
If you have Medicaid coverage and go to a Medicaid-approved physician, they will likely know what Medicaid doesn’t cover. What if you have Medicare and Medicaid dual eligibility? Original Medicare (Part A & B), will pay a portion of your expenses. Medicaid will cover any copayments, deductibles and coinsurance.
If you have only Medicaid coverage, Medicaid will pay the entire cost of the procedure if it is medically necessary.
How Much Does a Lasik Operation Cost without Medicaid?
In the US, Lasik costs an average of $2200 per eye. This is quite a large amount, considering that each eye takes only 10 minutes to perform. Depending on where you are located, Lasik can cost up to $4000 per eye.
Avoid hospitals that offer Lasik at a low price, like $500. You’ll likely find hidden costs later. Prices for Lasik depend on many factors such as the severity and location of the operation, the equipment used, the technology employed, and the type of refractive problem.
Before you commit to a surgeon, or clinic, it is important that you do your research. Many insurance companies, such as Medicaid, have a list that recommends eye specialists who meet certain standards of honesty and credibility. It is worth taking your time to find the right surgeon to ensure a successful and long-lasting Lasik procedure.
Do You Have Other Coverage Options?
You may be eligible for assistance outside of Medicaid if you must have a Lasik procedure. You can also use your HSA or FSA to pay for the procedure. These plans both cover laser vision corrections as per the RSC.
Depending on how much you have in your HSA/FSA account, you may be able to cover part or all of the costs. You can also consult your eye doctor about financing Lasik surgery. Many hospitals offer flexible payment plans or loans that allow patients to spread out the cost of their Lasik surgery over several months or years. These plans may not have interest but you will need to deposit an upfront amount.
Ask about hidden fees, late payment fees and prepayment penalties. Your employer may also be able to assist. Many companies offer discounts to their employees for eye surgery, dental work, and other services that Medicare or Medicaid does not cover.
Large enterprises offer vision benefits to their employees as part of their private medical coverage. Besides, if you have vision problems or wear glasses, you might consider purchasing vision insurance. According to the RSC (Refractive Surgery Council), some vision insurance providers offer discounts up to 50% for Lasik and refractive eye surgery.
Because Lasik is an elective procedure, Medicaid doesn’t usually pay for it. There are better options. Medicaid is controlled and funded by the states, coverage will depend on where you live, and whether or not the procedure is considered medically necessary.
For more information about Lasik, you can visit the Medicaid website or contact a local agency.