Key takeaways
- As an elective and cosmetic procedure, LASIK is not listed under the Medicare Benefits Schedule and is not eligible for bulk billing or rebates.
- Some premium health policies include limited benefits for laser eye surgery, though waiting periods and coverage amounts vary.
- Contact your insurer directly to check if your policy includes LASIK or related treatments, and request a written summary of inclusions and waiting periods.
- Consult your ophthalmologist before making a decision. They can assess your suitability for LASIK, explain potential outcomes, and help you weigh the costs against long-term benefits.
LASIK and health coverage in Australia: Separating facts from myths
Medicare is Australia’s national health insurance scheme, providing access to a wide range of health and hospital services at a reduced or no cost. While it covers many essential eye tests and treatments, elective or cosmetic procedures such as LASIK are generally not included.
This guide explains what Medicare does and doesn’t cover when it comes to LASIK, how private health insurance may help offset some of the costs, and what patients should be prepared for before undergoing laser eye surgery.
Does Medicare cover laser eye surgery such as LASIK?
LASIK, also known as refractive surgery, is designed to correct vision problems like short-sightedness, long-sightedness, and astigmatism by reshaping the cornea. Because it aims to reduce dependence on glasses or contact lenses rather than treat a medical condition, LASIK is considered an elective procedure rather than a medically necessary one.
As a result, Medicare does not cover LASIK or any related laser eye surgery costs. There are currently no Medicare Benefits Schedule (MBS) items that apply to standard LASIK procedures. This means you won’t be eligible for bulk billing, rebates, or Medicare subsidies for the surgery, surgeon’s fees, or associated hospital costs.
A common misunderstanding is that because LASIK improves vision, it should qualify for a Medicare rebate. However, Medicare only subsidises procedures that are required to treat or prevent medical conditions, such as cataract surgery or retinal treatments.
While Medicare helps Australians access many essential eye care services, laser vision correction procedures like LASIK are entirely self-funded unless your private policy includes refractive surgery benefits.
Can private health insurance cover LASIK?
For example, Medibank Gold Ultra Health Cover can provide a maximum amount of benefits towards LASIK in a calendar year of $3500 with a waiting period of 36 months, which is the time you need to wait before you can receive benefits for services or items listed in your cover.
However, if you’re switching from another health fund, or on similar cover, they generally recognise any waiting periods already served.
There are several private health insurers that cover laser eye surgery, though eligibility, waiting periods, and coverage limits vary depending on your policy level.
As with most elective surgeries, the health insurance policies that cover it are likely the higher level policies that include a range of extras, including laser eye surgeries such as LASIK, LASEK, and PRK treatment.
What patients should do: Checklist before booking LASIK
Before making the decision to go ahead with LASIK, it’s worth doing a bit of research and preparation. Understanding the costs, eligibility, and your coverage options can help you avoid unexpected expenses and work out the best course of action.
Here’s a quick checklist to guide you:
1. Check in with your ophthalmologist
Book a consultation to confirm you’re a suitable candidate for LASIK and discuss what fees apply. Your ophthalmologist can also explain the procedure, recovery process, and any alternatives that may better suit your needs.
2. Confirm your coverage with your health insurance provider
Contact your health fund directly and find out if you’re eligible. It’s best to get this in writing and to request the policy wording so you have confirmation. Also worth asking whether your plan covers any part of refractive surgery, such as consultations or follow-up care.
3. Explore payment or financing options
Many clinics offer payment plans or staged payment options to make the cost more manageable. Compare these options carefully before committing.
4. Weigh the benefits against the cost
If you’re considering premium LASIK technology or a newer laser platform, consider whether the higher cost aligns with your vision goals and expected outcomes.
Frequently asked questions
Yes, LASIK is considered a cosmetic procedure because it’s designed to improve convenience rather than treat a medical condition. Some people assume it qualifies as a medical need since it corrects vision, but options like glasses or contact lenses provide the same result without surgery.
Unfortunately not. LASIK isn’t considered a medical necessity in any circumstance because it doesn’t treat an underlying eye disease or condition. It’s designed to reduce dependence on glasses or contact lenses, making it a convenience-based choice rather than a medical one.
No, most private health insurers don’t include LASIK in their basic policies, and some don’t cover it at all. It’s usually only available under higher-level cover, with varying terms and conditions. It’s best to speak directly with your insurer to understand what options may be available to you.
Talk to Dr Geoffrey Ryan about LASIK surgery today
While LASIK can offer freedom from glasses and contact lenses, it’s important to know that it isn’t covered by Medicare and is only included in a limited number of high-level private health policies. Before booking, take time to research your options, confirm your coverage, and discuss your suitability with an ophthalmologist.
Every patient’s eyes and circumstances are different, so professional advice is the best way to understand your options and make an informed decision about laser vision correction.