When visiting the eye doctor, some people are surprised when asked for their medical insurance details. After all, aren’t vision plans supposed to cover eye care? While it might seem confusing, both vision and medical insurance cover different aspects of eye care services. Understanding what each covers can help you make the most of your benefits and avoid unexpected costs.
What vision insurance covers
Vision insurance is designed to cover routine eye care and eyewear. If you wear glasses or contacts, this type of plan helps make regular check-ups and corrective lenses more affordable. Here’s what vision insurance usually covers:
- Routine eye exams: These plans typically cover your annual eye exam, which is crucial for keeping your eyes healthy and your prescriptions up to date.
- Eyeglasses and contact lenses: Most plans offer coverage or discounts for frames, lenses, and contact lenses.
- Lens enhancements: Some plans help with costs for lens add-ons like anti-reflective coatings, photochromic lenses, or progressive lenses.
Vision insurance focuses on preventative eye care and vision correction needs, but it doesn’t cover medical conditions or treatments for eye diseases.
What medical insurance covers
Medical insurance, on the other hand, covers eye care related to eye diseases, injuries, and other medical conditions affecting the eyes. If you develop an eye infection, notice sudden vision changes, or need treatment for an ongoing eye condition like glaucoma, your medical insurance will typically apply. Medical plans usually cover:
- Eye infections, injuries, and diseases: Treatment for conditions like conjunctivitis (pink eye), styes, or corneal abrasions.
- Diabetic eye exams: Essential screenings for people with diabetes to check for conditions like diabetic retinopathy.
- Ongoing management of eye conditions: Coverage for managing chronic issues like dry eye, cataracts, or glaucoma.
- Emergency visits: If you experience sudden vision loss, eye pain, or flashes of light, medical insurance will usually cover your visit.
- Eye surgeries: Procedures like cataract surgery or treatments for eye injuries.
How to know which insurance to use
Which insurance you use depends on why you’re visiting. For a comprehensive eye exam to check for diseases and update your glasses or contact lens prescription, you’d use your vision plan. But if you come in for eye pain, redness, or sudden vision changes, or you need treatment for a medical condition, medical insurance will likely apply.
In some situations, both types of insurance might come into play. For example, if you have an eye condition like glaucoma, your medical insurance covers treatment. However, your vision insurance can still help pay for glasses if your prescription changes.
Maximizing your benefits
Understanding your insurance coverage can help you get the care you need while making the most of your benefits. At the Eyecare Center of Ken Caryl, we offer comprehensive eye exams in Littleton, Colorado, and advanced medical eye care to keep your vision sharp and your eyes healthy. Give us a call today or request an appointment online!