Vision vs Medical Insurance

Vision vs Medical Insurance – Clearing the Confusion

This is a question that we receive commonly so here are the key differences.

Vision Insurance covers annual wellness visits where typically the only complaint is blur and that blur is fixed by either glasses or contacts. These visits are similar to seeing your primary care doctor for your physical exam, and generally do not allow for us to provide medical services such as special testing, prescription eye drops, or other in office treatments. The nice thing about vision plans is that they generally have no deductible, and instead have set copays for exams and glasses/contacts.

Medical Insurance requires visits to be complaint driven. This means that these exams serve the purpose of addressing a specific problem (ie: dry eyes, ocular discomfort, or blur/glare associated with cataracts), but they can also serve the purpose of a comprehensive eye exam for patients with certain conditions or medications that require annual eye exams such as diabetes or plaquenil (a medication often used for rheumatoid arthritis). Unlike with vision plans, medical insurance costs can be hard to predict because they depend on your individual coverage as well as whether or not you have met your personal or family deductible. Because medical insurances are only concerned about taking care of your eye health, they do not cover checking your glasses prescription (refraction) or provide any assistance towards purchasing glasses or contacts. Dealing with the bureaucracy of different insurance companies can be frustrating and (depending on your condition) may require you to return for multiple visits in order for the insurance to cover testing that otherwise could have all been conducted in one visit.
We know this is an inconvenience, and we share in your frustration as it causes extra work for our staff as well. Just know that we are always on your side and feel free to give us a call with any questions that may come about.