Eye Surgery covered by Health Insurance?

It is a key question that can be hard to find does you health insurance cover you for eye surgery?
As an increasing number of people are choosing to use elective and cosmetic eye surgery procedures but its important to understand that it is not always coverage under your insurance policy.  Typically your health insurance does not cover laser eye surgery or refractive eye surgery but some policies may cover costs under certain criteria. This list is general information and not legal/medical advice:
  • eye surgery for errors that a result of surgery
  • eye surgery for errors that a result of an injury
  • patient is not able to wear glasses or contacts due to physical limitations
  • patient has severe refractive errors
You always need to check with your insurance company that you are part of the plan that provides the benefits you need for your situation and before you undergo treatment, don’t base all your decisions on a sole provider or what you read on the internet.
Does insurance cover the partial costs of Eye Surgery?
Some health insurance cover includes partial coverage for surgery services such as laser eye surgery but it is usually classed as elective surgery. A number of insurance companies can consider eye surgery a purely cosmetic procedure and not a necessary medical procedure. On a case by case basis some insurance policies will consider if the procedure is required and Medicare benefits will be available.
Where do I find if it is an excluded surgery service?
So most insurance companies will list this type of information under the “excluded service”. This is where they advise that no benefit is payable for any doctor or hospital charges that are associated with the procedure.
Typically “cataract and eye lens procedures” are not covered along with other procedures such as “joint replacement” and “renal dialysis”.
What about Health Insurance Tax Benefits?
There are tax benefits in having health insurance but you need to carefully check your policy that it will cover such cosmetic eye procedures before you undergo the procedure. Try speak direct with your insurance company or insurance broker and carefully check the terms and conditions as to what you might not be reimbursed for.
The upside is that many quality lasik clinics will offer free consultations and offer payment plans for their procedures. This can help in situations where your health insurance doesn’t cover the procedure.