Many people find eye care coverage confusing due to the distinctions between vision insurance and medical insurance. The most common questions revolve around what is covered, how often, and the associated costs. Below are some common questions about vision coverage. To help avoid unexpected health costs, be sure to ask your insurance provider or your eye care provider these questions before you receive services.
What is the difference between vision insurance and medical insurance?
Vision insurance covers routine eye care, such as annual exams, glasses, and contacts. Medical insurance covers eye injuries, infections, diseases, and their treatment.
Does my vision insurance cover glasses or contacts?
Most vision plans offer an allowance or discount for one or the other, but rarely both in the same year.
What are my co-pays and allowances?
A co-pay is a fixed fee you pay for a service (e.g., a $10 exam co-pay). An allowance is the maximum amount your plan will pay for a product, like frames, with you paying the difference.
How often are my benefits available?
Many vision plans allow for an exam once every 12 months, new lenses every 12 months, and new frames every 24 months. If you do not use your benefits, they do not roll over.
What about lens enhancements?
Many plans offer coverage for or discounts on popular lens upgrades like anti-glare, scratch-resistant, or photochromic (transitions) coatings.
Why was my medical insurance billed for my eye exam?
If your visit was for an eye infection, injury, or to monitor a medical condition like glaucoma, your provider will bill your medical insurance, not your vision plan.
Does my insurance cover medication for my eyes?
Coverage depends on the type of medication. Part D plans cover prescription eye medication for Medicare beneficiaries, while standard medical insurance covers it for those with private plans.
Will my medical insurance cover routine procedures like refraction?
Most medical plans, including Medicare, do not cover the refraction, which determines your eyeglass or contact lens prescription. This is considered a routine procedure and is usually covered by a separate vision insurance plan or paid out-of-pocket.
Is the doctor in your plan’s network?
Check the plan’s website to confirm if the eye care provider is in-network. Out-of-network care often results in higher costs or no coverage.
Can medical and vision insurance be used on the same day?
Both insurance types cannot be billed for a single exam visit. Separate appointments may be needed for routine vision needs and medical eye issues.
How can my benefits be maximized?
- Find an in-network provider.
- Understand copays and allowances for frames and contacts.
- Know the frequency limits on exams and eyewear.
- Inquire about discounts on services like LASIK.
Does the insurance cover LASIK?
Most vision and medical insurance plans consider LASIK an elective procedure and do not cover it. Some vision plans may offer discounts on the surgery.
Where can I find out more?
Do you have a story about access to eye care?
More about how eye care is covered by each type of insurance.
