Understanding Insurance Benefits for Eye Care

Many people find eye care coverage confusing because of the distinctions between vision insurance and medical insurance. We’re here to help you better understand how insurance may relate to your specific eye health needs. Please note that this guidance is general. Always review your plan carefully to understand your individual benefits.

Are you ready for your open enrollment period?

Use the following checklist to make sure you have all the information you need for the right plan to support your eye health:

Before choosing or renewing health coverage:

☐ I know whether I have Medicare, Medicaid, Marketplace coverage or another type of insurance.

☐ I checked whether my eye doctor is in my plan’s network.

☐ I checked whether my regular eye examination is covered.

☐ I checked coverage for my specific eye condition.

☐ I checked whether my eye medications are covered.

☐ I checked coverage for glasses or contacts if I need them.

☐ I checked whether I need referrals or prior authorization.

☐ I know what I will pay for eye care.

☐ I know when I need to renew my coverage.

☐ I know where to go if I have a problem with my coverage.

Why is Access to Eye Care so Important?

There are many reasons you may need eye care. You may need:

  • an eye exam for prescription eyeglasses or contact lenses,
  • treatment for an eye disease or eye condition,
  • an exam to diagnose symptoms you may be experiencing,
  • an eye exam at regular intervals as suggested by your doctor,
  • medicine for your eyes,
  • or you may want cosmetic or elective eye treatments.

How you access and pay for eye and vision care will depend on the type of insurance coverage you have and how well you understand these vision and eye care benefits.

Let’s explore the common vision health services covered by each type of insurance.