14120 Commerce Ave NE #100 Prior Lake, MN 55372

Keratoconus Insurance Coverage

Does Insurance Cover Keratoconus Treatments?

“Yes…and No”

Insurance coverage for keratoconus can vary from plan to plan and can be somewhat confusing so hopefully this article will be helpful but feel free to call our office with questions.

Key words to remember:

Vision Insurance Plans:  Vision Service Plan (VSP) and EyeMed are supplemental (additional) plans to your standard health insurance and can be purchased individually or offered at a group rate through your employer. These plans can be very beneficial in helping to pay for the cost in the treatment of keratoconus and other corneal disorders.

Standard Health Insurance: These plans include carriers such as Blue Cross Blue Shield, Medica, United Health Care, etc. and often only cover the cost of a routine eye examination and testing required in the diagnosing of keratoconus. In advanced cases, surgical treatments may also be covered.

Healthcare Savings Account (HSA), Flexible Savings Account (FSA): These accounts allow you to set aside funds “pre-tax” for keratoconus expenses not covered by your health insurance or vision plans. Please contact your employer or accountant for specific information.

Care Credit is a company that will allow you to make payments on keratoconus expenses not covered by your standard health insurance or vision insurance. We can help you set up a Care Credit account during your visit.

Treatment options and coverages:

Scleral Contact Lenses:  These specialty contact lenses are the best way to maximize vision in cases of keratoconus and other corneal disorders.  Most health insurance plans do not cover scleral contact lenses but Vision Service Plan (VSP) and EyeMed will usually cover most of the cost of scleral lenses when prescribed for keratoconus and other corneal disorders. Care Credit, HSA, and FSA funds can be used for any out of pocket costs for scleral contact lenses

Glasses and Standard Contact Lenses for Keratoconus: Standard health insurance rarely cover glasses or contact lenses for any eye condition medically necessary or not. Vision insurance plans will often pay for some of the costs of eyeglasses and standard contact lenses however these options are rarely effective for keratoconus. Rigid gas permeable contact lenses (RGP or hard lenses) are usually not covered by standard health insurance but are sometimes covered by vision insurance plans.

Corneal Crosslinking: Unfortunately, crosslinking is not covered by most health insurance at this time, but coverage is currently being debated. This is ironic as crosslinking can be very beneficial in stabilizing keratoconus and avoiding the much more expensive corneal transplant which is covered by most health insurances. VSP and EyeMed do not cover corneal crosslinking but Care Credit, HSA and FSA can be used for these procedures.

INTACS: Corneal INTACS implants are sometimes covered by health insurance provided the proper documentation that the procedure is medically necessary.

Corneal Transplantation: Most medical insurances will cover the cost of this procedure after all other treatment options have been exhausted.

Best way to maximize insurance benefits for keratoconus: Enroll in Vision Service Plan or EyeMed to maximize coverage for scleral contact lenses and use contributions to HSA/FSA accounts to pay for any out of pocket expenses.

Please refer to our treatments tab for full descriptions of treatment options:

Disclaimer: Coverages discussed above can vary greatly from plan to plan and state to state. They can also change at any time. We can be of assistance in determining your coverage but patients are ultimately responsible for payment. Please contact your insurance provider, tax expert, or accountant for more specific information.