Good Eyecare Coverage: Vision Insurance vs. Medical Insurance

Navigating eyecare expenses can sometimes come with a few surprises. Don’t be caught off-guard at a visit with an ophthalmologist or optometrist. Our primer helps break down various eyecare costs and which ones—like paying for new glasses or contacts—are likely to be covered by medical or vision insurance.

By

Sally Wadyka

| Reviewed by

Cindy Cork, OD

Even if you have good health insurance, a visit to your eyecare provider can sometimes come with a surprise bill. That’s because traditional medical insurance only covers medical expenses (eye diseases or injuries) not routine, preventive eyecare. Vision insurance—which is typically a separate policy—is a wellness benefit you can use for general eyecare.

 

What types of eyecare does medical insurance cover?

Medical insurance, as the name implies, is designed to cover expenses related to medical conditions. That means it will cover eye diseases and injuries—but not routine eye exams, contact lenses or a new pair of glasses. In order to use these benefits, you can visit an ophthalmologist (who is a medical doctor) or an optometrist. Learn more about which one may be right for you. 

 

In terms of eyecare, your medical insurance should cover things such as:

  • Chronic eye conditions, including glaucoma, macular degeneration, dry eyes, cataracts and diabetic retinopathy
  • Eye injuries
  • Eye infections
  • Eye surgery
  • Certain types of laser surgery (most insurance does not cover LASIK, laser vision correction)

 

What types of eyecare does vision insurance cover?

Vision insurance helps defray the cost of preventive vision screenings. It can also help pay for all or some of your vision correction needs—like contacts or prescription glasses. Many optometrists and ophthalmologists accept vision insurance for eye exams, contacts and glasses.

 

Should I add vision insurance to my coverage?

If you wear contacts or glasses, it may make sense to add vision insurance to your healthcare policy. In many cases, premiums are only about $10 per month for vision insurance that will cover eye exams and vision care. Most policies cover the costs of standard contact lenses or will offer a discount off premium lenses (such as multifocal or daily wear). If you wear glasses, your policy may also cover a portion (if not all) of the cost of new frames and prescription lenses. 


Vision insurance plans differ. Some policies will cover all your eyecare expenses up to a specific dollar amount. Others only provide a discount on eyecare services--such as 20 percent off covered visits and products. 


The best way to ensure that vision insurance will make sense for you is to take a close look at what your policy will cover. Then estimate the annual cost of your premium (individual and family plans will differ) and what you expect to pay for your eyecare exams, glasses or lenses during that period. 

 

The advantages of vision insurance can go beyond cost savings. If having vision coverage means you stick to your recommended schedule of eye exams and prescription updates, you could also protect your eye health. Regular screenings help detect the early stages of eye disease. And updating your prescription annually means you’ll never have to wear your contacts longer than recommended (which increases your risk of serious eye infections). 

 

QE Perspective: Your eyesight is too important to ignore, which is why you should never put off preventive eyecare. Check your policy to see what your medical insurance covers. If you need routine screenings and vision exams, you may want to consider adding vision insurance to your healthcare coverage. In most cases, the cost of the premium is offset by the discounted eye exams, contact lenses and prescription glasses. 


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