For many individuals, especially seniors, the hassle of wearing corrective lenses can be burdensome. While contact lenses require constant care, eyeglasses are prone to being misplaced or broken, presenting a challenge for seniors. However, there’s a more advanced and convenient solution available: laser-assisted in situ keratomileusis, commonly known as LASIK. This innovative procedure utilizes a surgical laser to reshape the eye’s lenses, resulting in permanent and natural vision correction. Seniors in good health can typically undergo LASIK with a high success rate and minimal adverse effects. Though Medicare’s coverage for LASIK is limited, some Medicare Advantage plans offer coverage for this procedure, as explained below.
Securing LASIK Eye Surgery Coverage Under Medicare: A Guide
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Part B Medicare: Original Medicare Coverage
Part B of Medicare encompasses outpatient procedures and treatments. While it is generally comprehensive, it often excludes preventive care for vision, hearing, and dental health. Consequently, normal LASIK to correct vision is not considered medically necessary since corrective lenses can serve the purpose. Nevertheless, the determination of medical necessity varies and is subject to change over time. In cases where LASIK is essential for preserving eye health and vision, such as traumatic injuries, Medicare may cover the procedure.
Medicare Advantage Plans: Expanded Coverage
In addition to standard Medicare, individuals can opt for a Medicare Advantage Plan (Part C), which fills the gaps in coverage provided by Part B. These plans are offered by private insurance companies but are regulated and approved by Medicare. While they must cover the same services as original Medicare, Medicare Advantage plans often provide additional coverage that extends beyond the conventional benefits. Some of these plans include coverage for LASIK for eligible individuals.
Example Plans:
- Blue Cross Blue Shield: Many BCBS Medicare Advantage plans offer coverage for LASIK under specific conditions, including:
- Previous cataract surgery or corneal transplant.
- A difference of more than 3 diopters between the eyes.
- Inability to achieve clear vision through glasses or contacts.
- United Healthcare: Their Medicare Advantage plans cover LASIK for astigmatism resulting from prior surgeries.
Navigating Coverage:
When enrolling in insurance, including Medicare Advantage, you receive information outlining the inclusions and exclusions. Reviewing this information can help determine if LASIK applies to your situation. Alternatively, you can ask your doctor to submit a preauthorization form to the insurance company, explaining why LASIK is the right choice for you. Providing medical records along with the request strengthens the case for coverage. Keep in mind that some surgeons have financial aid advisors who can assist with understanding benefits and submitting the necessary paperwork to determine insurance coverage eligibility.
Conclusion:
LASIK offers a modern and technologically advanced solution for seniors seeking vision correction. While original Medicare coverage is limited, exploring Medicare Advantage plans can reveal options for LASIK coverage. By understanding the requirements and working closely with doctors and insurance providers, seniors can pursue the benefits of LASIK with financial assistance when available. Don’t hesitate to seek guidance from financial aid advisors for a smoother insurance experience.
