Insurance can be complicated. It varies based on employer, age, and location, and unfortunately, no comprehensive guide exists to navigate it. Here is some information about the differences between medical and vision insurance and what to use when. Specifics will be dependent on your providers, but this should help you better distinguish between what’s available to you.
Vision vs Medical Insurance
Here are two scenarios:
- Your 8-year-old accidentally stabs himself in the eye with a pencil.
- Your glasses are scratched and you need a new pair with an updated prescription.
The first scenario is medical — medical insurance covers emergency care, surgery, and eye conditions like glaucoma or infection. Though it might dip into eye health, it has no coverage for routine vision services, like an eye exam.
The second is vision — vision insurance is a bit of a misnomer. It’s not really insurance so much as it is a benefit. It’s a supplemental, discounted program you pay into for preventive maintenance, so when it comes time for your eye exam, you have fewer and less expensive out-of-pocket costs. It doesn’t cover the treatment of diagnoses (like cataracts) but does cover the refraction portion and the wellness exam. Refraction is a vision test performed by your eye doctor to check if you need prescription lenses.
A typical vision plan includes a wellness eye exam, lenses and an allowance for contacts, frames or both. Instead of paying full-price at the time, you’re paying a discounted price each month. A vision plan can save you a few hundred dollars each year.
|Covers routine eye care services like eye exams and refractive services.
||Covers medical eye care services, such as management of eye diseases.
|Benefits typically include an allowance toward glasses and/or contact lenses.
||Only covers materials if you have a Health Savings Account (HSA) or Flexible Spending Arrangement (FSA).
|Benefit can only be used one time per calendar year or one time every other year.
||Benefit can only be used one time per calendar year or one time every other year.
Can be used multiple times throughout the year.
If you have further questions regarding which insurance benefit you should use for your eye exam, please ask your patient representative during scheduling or Contact Us anytime.
How Can I use Insurance for my Eye Exam?
You can get an annual eye exam using your medical insurance, but it would only include examining for eye conditions and would not cover a prescription for any type of corrective lenses. If you need both care for an eye condition as well as a wellness exam with refraction, you might have to make two different appointments because both insurances can legally not be billed for the same encounter. This can be avoided by paying out of pocket for your refraction and prescription. If you are only interested in getting a routine eye exam and refraction benefit from your vision insurance you will need to do both at the same time, on the same day, otherwise you’ll end up paying separately for both.
We encourage you to schedule an annual eye exam to catch eye conditions early and keep your eyes healthy. Visit the nearest Barnet Dulaney Perkins practice near you or call to schedule an appointment. If you’re unsure whether you should use your vision or medical benefits, please reach out to us or your local BDP clinic, and our team will be happy to guide you.