Is Keratoconus Covered by Health Insurance?

Is Keratoconus Covered by Health Insurance? in Manhattan

Treatment Can Be Expensive

As a medical condition, many of the available interventions and services for keratoconus care may be covered under general health coverage as a medical necessity. Your insurance company is best equipped to answer your inquiries about what coverage you are entitled to. 

Keratoconus is diagnosed following a comprehensive eye exam and topographic modeling of the cornea. With advanced medical technology today there are many options to treat this condition by preventing further corneal damage and improving vision. Unfortunately, many of these treatments are expensive. 

Without medical coverage, the lifetime costs to manage and maintain keratoconus can be exorbitant. The following are approximate figures for common procedures to treat keratoconus:

  • Cross-linking: Approximate costs in the U.S. for this outpatient procedure ranges from $2500 to $4000 per eye.
  • Corneal transplants: Can cost as much as $18,000.
  • Accumulated Cost: Another factor to consider is the lifetime cost of managing and maintaining this condition through the use of contact lenses, glasses, and exams. As keratoconus advances, more expensive speciality contacts are often required.

Depending on your ocular health, you will also have to consider if you need an additional vision plan. The following section will discuss the kinds of interventions that are commonly covered either in full or in part by many insurance plans.

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What Kinds of Treatment Is Usually Covered? 

There are many options to treat keratoconus. In the U.S. today, many of the costs are covered (in full or in part) by insurance:

  • Standard pair of glasses/contacts: These include standard prescription glasses for moderate cases and specialty lenses as the condition advances. Options include: soft and rigid lenses, scleral contacts, and hybrid and other gas permeable options. A proper fitting of lenses is essential to make sure that it meets your eye’s precise measurement.
  • Procedures: Corneal collagen crosslinking is used to treat moderate forms of this condition before vision loss and alterations become too severe. Crosslinking uses riboflavin and UV light to strengthen the eyes and to prevent further degeneration.
  • Corneal transplant surgical procedure: A procedure where diseased tissue is replaced with donor tissue. Scleral lenses may become necessary following surgery due to scarring. These are worn on the sclera rather than the cornea.

Speak With Your Provider

Every insurance plan is different. For specific information about your benefits and to determine what lenses and treatment may be covered by your policy, speak with your provider.

Speak With Your Provider

Common Questions

Speak with a provider to find out the specifics. As a medical condition affecting vision, you may be entitled to the coverage provided that it constitutes medical care, and not elective care.
Is Keratoconus Covered by Health Insurance?
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Medical Coverage and Progressive Keratoconus Patients

As a progressive ocular disease, keratoconus requires lifetime management to prevent corneal damage and to improve eyesight. The accumulated costs for medical intervention can be exorbitant. Fortunately, many interventions and procedures are either partially or fully covered by health coverage plans. For those without coverage, financing provides an additional way to pay for these interventions. 

Some of the available options today involve procedures to prevent further damage or reshape the cornea, while others are designed to improve eyesight. While moderate cases can often be treated with standard glasses and lenses, as the condition degenerates, it may require specialty contacts and surgical interventions. 

Speak with your provider to find out what kinds of interventions are covered by your insurance plan. Additionally, you will want to confer with your optometrist to create a comprehensive treatment plan that works for you.

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