LASIK (Laser-Assisted In Situ Keratomileusis) is a common surgical procedure performed to correct refractive errors in the eye, such as myopia, hyperopia, and astigmatism. This procedure reshapes the cornea to improve the eye’s ability to focus light onto the retina, often reducing or eliminating the need for glasses or contact lenses.
Standard Medicare Policy on Elective Procedures
Original Medicare (Part A and Part B) generally does not cover LASIK surgery. This exclusion is based on Centers for Medicare & Medicaid Services (CMS) guidelines, which primarily cover services deemed “reasonable and necessary” for the diagnosis or treatment of an illness or injury. Since visual acuity correction can typically be achieved with non-surgical means like eyeglasses or contacts, LASIK is categorized as an elective procedure.
The procedure is not considered essential medical care to restore function, but rather an optional enhancement to reduce dependence on corrective lenses. This classification places it outside the scope of covered benefits under Original Medicare.
Medically Necessary Refractive Procedures
While LASIK is not covered, there are specific exceptions where refractive correction becomes a covered service because it is an integral part of treating a covered disease or injury. Coverage may be extended to procedures that correct a refractive error caused by a previous covered eye surgery or trauma, especially when standard glasses or contacts are ineffective. This coverage is tied to the medical necessity of treating the underlying condition, not the elective desire for vision correction.
A common example occurs after cataract surgery, which Medicare covers when medically necessary to restore vision. Following the removal of a cataract, Medicare Part B covers the implantation of a conventional intraocular lens (IOL). The coverage for the IOL and one pair of post-operative corrective lenses is provided as a necessary component of the covered cataract treatment.
Alternative Coverage Through Medicare Advantage
Medicare Advantage plans (Part C) are offered by private insurance companies approved by Medicare and are required to cover all the same services as Original Medicare. These private plans often include supplemental benefits that Original Medicare does not, such as vision, hearing, and dental coverage.
Some Part C plans may offer vision benefits that include discounts or allowances for elective procedures like LASIK, though full coverage for the surgery remains uncommon. Coverage for LASIK varies significantly from plan to plan, and beneficiaries must review their specific policy details to determine if any financial assistance or discount is provided. A Part C plan may require physician documentation supporting a medical reason before authorizing coverage, even if it is a supplemental benefit.
Vision Services Medicare Does Cover
Original Medicare Part B covers a range of eye care services only when they are related to the treatment of an illness or injury, not for routine vision correction. Medicare covers diagnostic tests and treatment for glaucoma, especially for high-risk beneficiaries, such as those with diabetes or a family history of the condition. This coverage includes an annual glaucoma screening if the beneficiary meets the high-risk criteria.
Treatment for other specific medical conditions is also covered, including services for Age-Related Macular Degeneration (AMD) and diabetic retinopathy. Cataract surgery, which involves removing the cloudy lens and implanting an intraocular lens, is covered by Part B when medically necessary to improve vision. Coverage is strictly limited to the necessary medical treatment of the disease or condition, aligning with the “reasonable and necessary” standard for benefits.