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Does Insurance Cover ICL?

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ICL is considered a cosmetic and elective surgery that most general and vision insurance plans do not cover.

You can often use a special health spending account to offset or reimburse the costs of an elective procedure like ICL.

Insurance Coverage for ICL

Vision insurance is often a supplemental option that you add on to your general health insurance plan. It can help to provide coverage for regular eye exams and prescription eyewear. However, it will not regularly offer coverage for cosmetic and elective procedures such as LASIK or ICL.

An implantable collamer lens (ICL) is an artificial lens that is placed in front of the eye’s lens and behind the iris to correct myopia (nearsightedness), astigmatism (irregularly shaped cornea), or hyperopia (farsightedness). It is often done as an alternative to LASIK for people who are not good candidates for that procedure.

Usually, only eye surgeries that are deemed “medically necessary,” such as cataract surgery, are covered by health or vision insurance. ICL is not typically covered by either.

Some vision insurance companies offer discount programs that can be used to help partially cover or offset the cost of cosmetic eye surgeries, however.

Terms of Coverage

A discount vision plan will usually offer you a set amount off covered services, such as 15 or 20 percent off. Not all of these plans will cover cosmetic procedures like ICL, so be sure to read the fine print.

For plans that do offer this discount, you will pay the difference in cost out of pocket. ICL can cost between $1,500 and $5,000 per eye on average.

Often, health insurance plans and employers will set up health care spending accounts that can be used to pay for medical and surgical procedures, including ICL. Different types of spending accounts that can be used for ICL include:

  • Flexible spending accounts (FSA). This is a tax-exempt account you can place money in to pay for out-of-pocket health care expenses. Your employer can contribute to this account as well.
  • Health savings accounts (HSA). This is a pre-tax account you can contribute to if you have a high deductible health plan (HDHP). You can then use the funds to cover qualified medical expenses.
  • Heath reimbursement arrangements (HRA). Also called a health reimbursement account, these tax-free accounts are set up and owned by employers. Funds can be used to cover qualified medical expenses, up to a set and fixed amount.
  • Limited care flexible spending accounts (LCFSA). This increases your savings with an HSA by adding coverage for eligible out-of-pocket vision expenses as a pre-tax benefit. You can choose how much to contribute based on how much you plan to spend on these expenses in the coming year.

Getting the Best Coverage for ICL

If you have a discount vision plan, check with your provider to find out what they consider covered services. You will then need to know how much, and what percentage, of coverage they will offer for ICL.

Generally, ICL will be covered the same as LASIK under a discount vision plan. Keep in mind that ICL will cost more than LASIK, as it is a customized lens and requires a slightly longer and more invasive surgery.

To use a health care spending account, you can often pay straight from the account. To get the best coverage for an ICL, you will need to let the money in the account accumulate. Typically, a certain amount is placed into this account from your paycheck every month. This amount can be matched to a certain extent by your employer as well.

Depending on the type of account you have, you can accumulate and roll over funds year to year, or you may have to use the funds within one year. Some of these accounts, like the LCFSA, allow you to choose how much to contribute based on what you plan to spend. If you plan ahead for your ICL, you can save up the money and contribute to the account each month pre-tax, which saves you up to 30 percent on the total cost.

Many health care spending accounts work through reimbursement. This means you will pay for the services first and then submit a claim to be reimbursed through your account. You will need to ensure that the funds in this account can be used to cover an ICL since your vision or health insurance does not cover it.

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