Many people are surprised to learn that vision insurance and medical insurance are two different things. Which one pays can depend on why you are seeing the eye doctor.
Key takeaways
- Vision plans generally cover routine care such as eye exams and glasses.
- Medical insurance may apply when an eye problem is a medical issue.
- Original Medicare does not cover routine eye exams for glasses or contacts, but does cover certain medical eye services.
- HealthCare.gov says all Marketplace plans include vision coverage for children, while only some include it for adults.
What vision insurance typically covers
HealthCare.gov describes vision coverage as a benefit that at least partially covers vision care, like eye exams and glasses. Vision plans are often separate from your health plan. They commonly address a routine eye exam and an allowance toward glasses or contacts. Our post on the frame allowance explains the allowance.
What medical insurance may cover
When a visit is about a medical eye issue, such as an eye infection or a condition connected to another health problem, your medical insurance may be billed instead. The rules depend on your plan, so check with your insurer.
Marketplace and Medicare
- Marketplace plans: the HealthCare.gov says all plans in the Health Insurance Marketplace include vision coverage for children, and only some plans include vision coverage for adults.
- Original Medicare: Medicare.gov says that Medicare does not cover routine eye exams for eyeglasses or contact lenses. It does cover some medical services, such as eye exams for people with diabetes, glaucoma screenings, and macular degeneration tests and treatment.
- Medicare Advantage: some plans offer vision benefits that Original Medicare does not, so check your specific plan.
One visit, two kinds of insurance
A single visit can involve both kinds of coverage. For example, a routine exam may be billed to your vision plan, and a medical concern found during the visit may need to be handled under your medical benefits. Ask the office before your visit so there are no surprises.
How to find out what you have
- Find your insurance cards and note each plan name.
- Call the number on the card or log in to the plan website.
- Ask whether routine eye exams and glasses are covered, how often, and with what copays.
- Call us with the plan name and we will tell you how it applies at our office.
Frequently asked questions
Do you accept my insurance?
We accept most major insurance plans, and benefits vary by plan. Please call or message us with your plan name and we will confirm before your visit.
Are children’s eye exams covered?
HealthCare.gov says all Marketplace plans include vision coverage for children. Check your plan for the details.
Visit Reel Optics in Old Bridge
If you would like help, our team in Old Bridge is here. You can book an eye exam or ask about vision insurance at Reel Optics Vision Center, 2553 County Rd 516, Old Bridge, NJ 08857. Appointments are recommended for eye exams, and walk-ins are welcome when you are shopping for glasses. See hours and directions on our Old Bridge page, or send us a message.
Related reading
Sources and further reading
This article is general information, not medical advice and not a diagnosis. For questions about your own eyes, talk with your eye doctor.
