Vision Insurance versus Medical Insurance

Whether or not insurance covers eye care is a common area of confusion. There are two types of coverage that people often have that cover different eye care needs.

"Vision plans" cover routine eye checkups, which often lead to an eyeglasses and/or contact lenses prescription. Vision insurance does NOT cover medically-related eye problems, such as:

  • Red or painful eyes
  • Loss of vision
  • Diabetic eye disease
  • Glaucoma
  • Eye injury
  • Cataracts
  • Flashes of light
  • Macular degeneration

These types of problems are covered under your standard medical insurance.

Vision plans are usually an option above and beyond what is generally referred to as medical insurance, and they only cover completely routine eye exams. For example, if you have diabetes, your should have a dilated medical eye exam annually. Your medical insurance should cover this visit. However, if you also want to get a new pair of glasses or if you have a vision plan, you will need to schedule another appointment for a different date to have an eyeglasses-oriented, vision related visit, or pay out-of-pocket for the non-medically covered eyeglasses/contact lens prescription. Note that some offices only accept medical insurance, and do not accept vision plans or vice-versa. You should contact your eye doctor's office to determine this.

Vision plans usually cover routine care visits once every year or two, whereas medical insurance c an be used any time you encounter a medical eye problem.

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