Insurance / Vision Plans

Medical insurance and vision plans can be a real headache for both patients and healthcare providers. Let us explain the difference betwen the two and how they are used in the eyecare industry!

Medical insurance and vision plans in a nutshell

A vision plan policy is vastly different from your medical insurance policy. In eye care, many medical insurance plans will help cover regular eye wellness exams or even prescription eyewear. However, all medical insurance plans can be used for examination, diagnostic testing, and treatment for eye disease (dry eyes, ocular allergies, cataracts, glaucoma, macular degeneration, etc.), systemic disease (diabetes, hypertension, autoimmune disease), vision loss, eye injury, or eye infections. In contrast, vision plans only help cover some of the costs associated with the examination of healthy eyes, prescription eyewear, or contact lenses. 

What do vision plans cover? 

Most vision plans typically include the following benefits: 

• Annual examination of healthy eyes
• Eyeglass Frames + Eyeglass Lenses
• Contact Lenses (in lieu of eyeglasses)

*Your vision plan may have a copay associated with the examination and or materials. Check with your plan to understand your benefits or see how frequently your benefits reset.*

What does my vision plan NOT cover? 

Vision plans do not cover any part of an eye exam or service considered medical. For example, vision plans will not cover examinations or diagnostic testing related to vision loss, floaters, dry eyes, cataracts, allergies, infections, eye disease, or eye exams for complications from diabetes. Additionally, some vision  plans may not cover contact lens evaluations for new or established wearers. 

What about Medicare? 

Medicare will cover regular and urgent eye exams related to medical complaints or medical conditions. Medicare does not cover the determination of a prescription for glasses (refraction) or contact lenses. Most medicare plans will only cover one pair of eyeglasses after cataract surgery. Thankfully, we are able to offer very affordable options for eyeglass frames and lenses for our patients!

When you call in to make your next appointment, make sure to explain the purpose of your visit to the staff member so that we can make your visit as seamless as possible. Additionally, please bring your insurance card(s) with you to every appointment.