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When Does Humana (HUM) Cover LASIK and Eye Surgery?

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Humana is a private, for-profit health care company, providing medical insurance for nearly 17 million Americans as of the end of 2020.

Humana offers supplemental vision insurance that provides discounts on LASIK and PRK procedures. Unfortunately, none of Humana’s vision plans or other medical plans cover LASIK and PRK surgeries. Both corrective procedures are considered elective and, as such, are not covered by most medical insurance policies.

When a physician deems eye surgery as medically necessary, such as in the case of cataracts, Medicare or Humana health insurance may cover all or part of the cost of the procedure.

To obtain the highest discounts for LASIK, patients need to have treatment provided by an in-network Humana provider. A Medicare-participating physician may determine that certain eye conditions require surgical corrections that may be covered through Humana Medicare coverage.

Humana’s vision insurance plans provide coverage for a yearly vision exam and, after a co-pay, an annual allowance for new lenses for your glasses or an allowance for standard contact lenses. A Humana representative can guide you through what your specific insurance plan will cover and at what rate.

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Humana Discounts for LASIK and Eye Surgery Coverage

LASIK (laser in-situ keratomileusis) is an FDA-approved surgical eye procedure that changes the shape of the cornea to correct common refractive errors. It permanently changes your vision to the point that you likely will no longer need corrective eyewear (glasses or contact lenses).

LASIK is considered an elective procedure – and often a cosmetic one. As a result, it is not usually covered by health insurance.

However, Humana offers discounts on LASIK procedures. As a member of Humana, you can receive up to 15 percent off standard LASIK pricing (and 5 percent off promotional pricing) at specified in-network providers.

Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. Procedures can cost from $700 to $2,000 per eye, depending on the provider, location, and whether or not the services are traditional or customized.

You can use a different and independent LASIK surgery provider and still receive a discount of 10 percent off the usual cost of the services, as a HumanaVision member. Fees can’t exceed $1,800 for conventional/traditional or $2,300 for customized LASIK per eye.

The cost for LASIK can vary greatly and get up to around $4,000 per eye, so these discounts can be substantial.

Routine eye exams and vision care, as well as contacts and eyeglasses, are not covered through Medicare, Humana explains, but Medicare Part B does include a simple vision exam within the first year of coverage. Annual exams are only covered if you suffer from diabetes and diabetes retinopathy. Diagnostic eye exams checking for macular degeneration or glaucoma may also be covered at 80 percent.

Eye surgery, even for cataracts, is not deemed medically necessary. Therefore, it is not covered through traditional Medicare.

With Humana’s Medicare Advantage plan, you can opt for a MyOption Vision Plan that offers routine eye care as a covered service. This may then cover eye surgery, such as cataract surgery involving the placement of an intraocular lens. Surgery coverage will depend on whether the procedure is performed on an inpatient or outpatient basis, the provider used (in-network versus out-of-network), and where you live.

Using Humana Coverage for Eye Surgery or a LASIK Discount

patient receiving cataract surgery

If you have Humana vision insurance coverage or supplemental coverage that comes with being a member of HumanaVision, you can receive discounts on LASIK services. You will need to remain current with your monthly premiums. You will then need to schedule a comprehensive eye health exam with your doctor who can help you decide if you are a candidate for LASIK.

If you suffer from mild to moderate nearsightedness (myopia) or astigmatism (irregularly shaped corneas) and currently wear contacts or eyeglasses, you may be eligible. If so, you will need a referral from an in-network medical provider.

Humana partners with the following network providers and centers that can provide LASIK services for a set fee as explained:

  • LasikPLUS: This offers conventional LASIK for qualified candidates using IntraLase for $695 per eye with free enhancements for one year, or for $1,395 per eye with free lifetime enhancements. Customized LASIK using IntraLase for $1,895 per eye with free lifetime enhancements is available.
  • TLC designated locations: These offer conventional LASIK for $895 per eye, customized LASIK for $1,295 per eye, and customized LASIK using IntraLase for $1,895 per eye.
  • QualSight LASIK: This offers conventional LASIK for $895 per eye with free enhancements for a year, or for $1,295 per eye with a QualSight Lifetime Assurance Plan. Customized LASIK is available for $1,320 per eye, or for $1,995 per eye using IntraLase with a QualSight Lifetime Assurance Plan.

Prices, services and procedures vary based on your city and state of residence and by the eye care specialists that you use.

You can receive LASIK discounts from out-of-network providers as well. Your HumanaVision ID card entitles you to these discounts.

A customer care specialist can help you determine your coverage, obtain a referral, and set you up with a LASIK provider. LASIK providers often offer affordable payment plans to help you budget for services.

To use Humana Medicare Advantage plans to help pay for eye surgery, you will need a referral from an in-network doctor who deems the procedure medically necessary. (This is usually for cataract surgery, a condition relating to aging as tissue builds up on the eye lens.) Cataracts often require a complete lens replacement to clear up cloudy vision.

Doctors’ visits will usually incur a copay, which is a set amount that is due upon receiving services. Your annual deductible, the amount you need to reach before coverage begins, will also apply to eye surgery. You will generally be responsible for 20 percent of the cost of eye surgery services, and you will need to use an in-network provider.

Depending on which state you live in and your specific Humana Medicare Advantage plan, services may be covered at variable rates. Your coverage may stipulate if surgery can be completed on an outpatient basis or if it is required to be performed as an inpatient.

Humana Vision Plan Coverage

Humana’s vision insurance plan provides coverage for in-network and out-of-network providers. It covers an annual vision exam and gives members an annual allowance for new eyeglass lenses or new contact lenses.

Members can pick an upgraded plan if they desire. Upgrades include coverage options for progressive lenses, tinted lenses, anti-scratch coatings, etc. They also provide allowances for new eyeglass frames (every 12 months or every 24 months) and have discounts for LASIK and PRK surgeries.

Costs start at $12 a month and go up as customers add upgrades.

What Humana Doesn’t Cover

Medical or surgical treatment of the eyes is one of four areas that HumanaVision does not cover for patients. The other three areas are:

  • Orthoptics or vision training subnormal vision aids and Plano lenses (non-prescription lenses)
  • Replacement lenses for lost or broken glasses unless the replacement time coincides with an interval that allows for new glasses or lenses
  • Any care provided through or required by any government agency or program, including workers’ comp

The allowable time span for new frames and lenses is 24 months for people who are 21 and older.

Overall, these non-coverages are standard throughout the insurance industry.

References

  1. 2020 Annual Report. Humana.
  2. 2021 Provider Manual. (2021). Humana.
  3. Humana Sites. (2021). Humana.
  4. LASIK. (March 2018). U.S. Food and Drug Administration.
  5. Savings Center. (2021). Humana.
  6. Humana Vision Insurance. (2019). Humana.
  7. HumanaVision LASIK. Humana.
  8. Vision Coverage: Does Medicare Cover Eye Exams? (October 2018). Humana.
  9. Get Started with Humana Medicare. (January 2019). Humana.

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