The Difference Between Medical and Vision Insurance

Vision insurance is not medical insurance, right?

There is always confusion between the differences between vision insurance and medical insurance. This article will explain the differences between the two, but always call ahead to your doctor’s office to make sure you are covered.

Vision coverage is usually an add-on to your regular health insurance, but some eye care visits are considered medical visits and are covered by your health insurance.

Vision Insurance and Vision Plans

The difference is why you are having the exam. If it is an eye exam to update your eyeglass prescription, then only a vision plan will cover that visit and a portion of the frames, lenses, or contacts prescribed. 

Also, vision plans usually put a limit on how often your eye exam will be covered, which is usually every two years. However, some plans cover an annual eye exam.

Vision plans do not cover the costs for treating an eye injury or an eye disease. Your medical insurance covers those costs. 

What happens if you have an eye exam for a glasses or a contact lens prescription and the eye care practitioner finds an eye disease? In that situation your vision plan will pay for your eye exam and also their proportional coverage of your contacts, or frames and lenses. Then, your medical insurance will cover the subsequent office visits and any further testing that is required for your medical eye condition. 

You can’t use both vision and medical coverage for one visit. The subsequent exams and treatments for your eye condition or disease will be covered by your medical insurance. 

Basic vision plans usually cover these services:

  • Eye examinations and vision tests
  • A portion of your prescription lens and frames
  • A portion of your contact lens costs
  • Lens protection, such as scratch-resistant coatings

Premium vision plans cover those basics and may also add coverage for the following:

  • Disposable contact lenses
  • Progressive lenses
  • High-index lenses
  • Photochromatic lenses
  • Anti-reflective coatings
  • Polarized sunglasses
  • Discounts on LASIK and other elective vision correction

What are vision discount plans?

A vision discount plan offers discounts on vision services. When you join a vision discount plan, you become a member of a large group that has negotiated discounted fees with a network of eye care providers.

Common eye conditions that your medical insurance covers:

  • Eye infections
  • Allergies affecting your eyes
  • Dry eyes
  • Eye floaters
  • Monitoring the vision of patients with glaucoma or diabetes
  • Eye injury

Who should get vision insurance?

Regular eye exams, even if you have perfect vision, are helpful in detecting hidden medical problems.  However, if you only need routine exams, and don’t need the coverage for frames, lenses, or contacts, then getting vision insurance might not be worth it. But if you do need corrective lenses in addition to preventive care, you should definitely consider getting vision insurance. 

Every plan is different so be aware of all the covered expenses and the possible deductibles and copay options of the plans offered during your enrollment period so you choose the plan best for you and your family. 

If you would like to make an appointment, call us 609.877.2800 or EMail us.

Gregory Scimeca, M.D.
Ophthalmologist and Medical Director
The Eye Professionals

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