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Vision problems affect a vast majority of the U.S. population. Nearly 75% of Americans rely on some form of vision correction. One study found that 40% of people have vision issues at age 30 (after which our eyesight rapidly declines), and over 90% of people need vision correction by age 55.
For some, LASIK surgery seems like the right solution. The final decision frequently comes down to this question: Will my health insurance pay for it?
Unfortunately, unless LASIK is deemed the only medical option to treat a serious eye problem, it’s unlikely that your health insurance policy covers refractive surgery. But let’s look at the issue in more detail.
What Is LASIK?
LASIK (laser-assisted in situ keratomileusis) is a form of “refractive surgery” (a procedure that corrects vision). The science behind LASIK came together in the U.S. during the late 1980’s, following a Russian eye surgeon’s discovery that cuts to the cornea improved vision. The procedure was approved by the Food and Drug Administration (FDA) in the late 1990’s, and it is now the most common elective surgery in America.
Until the 1950s, glasses were the only form of vision correction available. Contact lenses were fully introduced in the 1970s, and became universally popular in the 1990s. Now 10% of us, more than 30 million people in the United States, wear contact lenses.
Today, thanks to LASIK – as well as similar procedures known as RK (radial keratotomy) and PRK (photorefractive keratectomy) – people with eyesight issues have access to many different options to improve their vision.
LASIK changes the shape of the cornea, the transparent window at the front of the eye. The Mayo Clinic describes the procedure this way: The Lasik uses a laser to remove tissue from the cornea. To get to the cornea, a surgeon cuts a hinged flap away from the front of the eye. Then after reshaping the cornea with a second laser, the surgeon lays the flap back into place. Most people’s eyesight improves immediately, and it gets even better in a week or two as the eye stabilizes.
As scary as shooting lasers into your eyes may sound, LASIK, RK, and PRK are all considered safe surgical procedures. Any of them may be an option for those who no longer want to deal with the inconveniences and expense of wearing glasses or contacts. If you choose to have laser eye surgery or another vision correction procedure, it’s possible to save a substantial amount of money on vision assistance items. But it’s unlikely the procedure will be covered by insurance.
Coverage for LASIK Is Rare
For the most part, health insurers will pay only for glasses or contacts. “Insurance has taken the position that LASIK is cosmetic,” said Dr. Charles R. Moore, the founder of International EyeCare in Houston, Texas.
Your healthcare provider will probably cover some, or all, of the cost of a pair of glasses. But if you want an expensive designer pair, or need bi-focal glasses, you will most likely pay a good portion of that expense out of pocket. Similarly, though many experts see pointing lasers into your eyes to improve your eyesight as a health-related procedure, high-end refractive surgery isn’t typically viewed as medically necessary by insurers.
Keep in mind, though, that even without insurance to share the cost of surgery, there are financial benefits to LASIK, particularly if you buy high-end contact lenses, designer eyeglasses or special bi-focal lenses.
How Much Does LASIK Cost?
Whether you’re insured, underinsured, or totally without coverage, the costs of LASIK surgery will likely end up being paid out-of-pocket (at least in part).
In 2020, the average cost for LASIK surgery was around $3,000 per eye. Costs vary greatly, however, and LASIK can run anywhere from $1,000 to $4,000 per eye. Beware of providers offering LASIK surgery for extremely low charges such as $300 — often you’ll be hit with hidden costs later.
As we said, vision insurance most likely won’t cover LASIK surgery. Most plans offer eye exams and glasses at a fixed rate, but no major vision plans have listed fixed rates for refractive LASIK surgery. A few employers may offer some coverage for LASIK if your need is a result of an injury. Ultimately, for the majority of individuals, the final price will depend on your current prescription, as well as your doctor. (Many LASIK surgeons offer large discounts from the posted price as an incentive to attract customers).
Some surgeons advertise a flat, fixed price for a single-day LASIK procedure that treats both eyes. Beware. The FDA does not recommend such deals for fear doctors will cut corners, like not providing proper follow-up care. To help avoid receiving such inadequate care, the FDA encourages patients to compare multiple doctors before trying LASIK.
Ways to Pay for LASIK Surgery
Fortunately, if you need LASIK surgery, there are seven payment options you can consider.
1. Vision Insurance
If your health insurance operates its own vision plan, it may have a special arrangement in place with a local LASIK practice. Contact your provider for more information.
Your health insurer may have also outsourced its vision benefits to one of the major standalone vision care plans:
- Davis Vision offers steep discounts with preferred providers, generally from $1,000 to $2,000 per eye.
- VSP has negotiated discounts with their network generally offering LASIK between $1,000 to $3,000 per eye.
- EyeMed offers a 15% discount off standard LASIK prices or 5% off promotional prices, if you use a doctor in a specified network.
2. Out-of-Pocket
You can, of course, pay for refractive surgery on your own. Many doctors offer monthly payment plans. On the other hand, LASIK providers may offer a steep discount if you pay your bill in full with cash.
And, of course, check whether your insurer offers any sort of reimbursement, before you set out on your own.
3. Flexible Spending Account (FSA)
FSAs have a number of tax-cutting advantages, primarily that you contribute pre-tax dollars from your paycheck into those savings accounts to cover future medical bills. If your employer offers an FSA, you can use it to cover all or part of the cost of refractive surgery. Check with your specific FSA plan to see how much of the cost is considered an eligible medical expense.
For 2020, the maximum FSA contribution is $2,750, meaning you may need to put the maximum amount into your FSA for more than a year to cover the surgery.
4. Union or Labor Health Insurance
Comprehensive labor union health plans sometimes pay for a portion of the costs of refractive surgery. Some speciality unions, such as the one for operating engineers, consider corrected vision necessary for employment and pay $1,000 towards the cost of the procedure. So, always, check with your employer health plan before you go shopping for care.
5. Medicare and Medicaid
Medicare and Medicaid will not pay for refractive surgery unless it is medically necessary. Conditions that make the procedure medically necessary include:
- When the refractive damage is a result of injury
- When the refractive damage is the result of a previous surgery
- When the refractive damage is severe
- If the patient cannot wear glasses or contact lenses because of physical limitations
Sometimes Medicare and Medicaid providers contract with an outside company to cover vision benefits; that company will likely steer you to their preferred doctors for a discount.
6. Army, Navy, Air Force, Marines and Coast Guard
It’s not unusual for members of the armed forces to receive refractive surgery, though they may have to get in line and wait. Glasses can be a burden and contact lenses are generally prohibited in combat zones, so the government understands the need to improve your eyesight before deployment.
PRK is more common than LASIK in the military, but both options are available. Each branch has a different policy for enlistees to obtain refractive surgery. An active duty service member can ask for details through their chain of command. However, once you retire from the military, you and your family members are not eligible for LASIK through the VA.
7. If You Have a Serious Eye Condition
Of course, if you have serious vision problems that would be best treated by LASIK or other refractive surgery, then your health insurance will pay for LASIK surgery as it would any other medically necessary procedure. Insurers will typically need a comprehensive diagnosis from an ophthalmologist or qualified physician explaining why glasses or contact lenses would not be a suitable alternative.
Are Retreatments or Complications from LASIK Covered?
Most doctors will provide surgical follow-ups free of charge within the first year of your LASIK operation. But expect to be billed for other complications at your doctor’s discretion. It’s always best to ask about follow-up care and common complications with the surgeon before the procedure. And get the understanding in writing to protect yourself.
Keep in mind that you may need a retreatment in five or ten years; that’s not at all uncommon.
Once your eyes have recovered from LASIK, the large majority of patients should be able to rest easy and enjoy clearer vision. However, as with any medical procedure, there is the chance of complications. For example, you may experience dry eyes, and that can become chronic.
In addition, , there’s a small chance of a traumatic eye injury, including scarring of the cornea. Should this occur, your follow-up care will most likely be covered by vision insurance.
In general, LASIK surgery improves the lives of many patients, though they probably have to pay for the convenience of not having to wear contacts or glasses out of their own pocket. If you are considering the procedure, do your homework, find a reputable doctor and check with your insurance to see if you luckily have some level of coverage.
