What is the difference between a vision and medical visit?

Vision Insurance

Vision insurance covers routine eye exams (wellness eye exam) and often provides allowances towards new frames, eyeglass lenses, and contact lenses.

A routine eye exam includes a comprehensive exam of the eye and a refraction test to determine your eyeglass prescription. Some patients may elect to do a Contact Lens exam and fitting as well. Certain vision insurance plans may provide a limited contact lens evaluation benefit while others will not. 

If your routine eye exam reveals a medical condition or disease related to your eye and visual complaints, or if the exam is due to a pre-existing condition such as cataracts, glaucoma, diabetes, dry eye, etc., then your visit won’t be covered by vision insurance, but rather medical insurance.

To summarize, vision insurance generally covers:

• Routine Eye Exam
• New Frames (frequency depends on plan)
• New Single Vision or Progressive Lenses
• Blurry Vision complaints Related to Updating Your Prescription
• Often Some Benefit towards Contact Lens Exam

None of these, however, will be covered by medical insurance. Though seeing clearly enables us to enjoy our daily activities, it is not considered a medical necessity by your medical insurance provider.

Medical Insurance

Medical insurance, or health insurance, will generally cover eye-related medical problems discovered during an optometrist’s eye exam. Medical insurance does not cover refractive care (glasses check or refraction). If a new glasses prescription is requested at a medical visit, there will be an out of pocket cost for the refraction.

Some examples of a medical eye visit may include:

This type of visit should be covered the same way any visit to a medical specialist is covered. Your medical insurance will be billed for the eye exam since you are being treated for a medical condition. As is typical for medical services, you may be responsible for copays, coinsurance, and deductibles depending on the specifics of your insurance plan.

Expect to pay any medical insurance copays, coinsurance, and deductibles at the time of your exam. If we file your claim with your medical insurance, you can still use your vision plan benefits towards the purchase of frames, lenses or contact lenses, all depending on your plan’s allowances.

Unfortunately, you cannot use your vision and medical insurance for a joint examination on the same day. That said, we can always schedule your medical and vision visits on separate days.