Vision and Medical Insurance

Despite being marketed as such, most vision plans are not really an “insurance” plan but more of a type of discount program for eyewear and related products.

Many people become flustered when trying to decide if purchasing extra vision insurance is a viable option for them.The following article addresses the differences between medical insurance and vision insurance, and what they generally provide coverage for.

Our eye doctor has extensive experience in helping people with their questions about different insurance options. Schedule an appointment today to find out more about the available options.

What is the Difference Between Vision and Medical Insurance?

The differences between the kinds of benefits that vision and health insurance each provide, aren't always clear. Being that many aspects of eye care are not covered with standard medical coverage, it is important to know the differences. The following article will explain the benefits of each type of insurance. Depending on your individual needs you will be able to decide if you require extra coverage.

Medical Insurance

Regular health insurance provides overall care for eye damage or disease, but doesn't cover routine eye exams, eyeglass frames, or prescription lenses for glasses or contacts. Certain ocular exams and procedures may be covered depending on the following:

How A Visit Is Defined: Coverage depends on how a doctor defines an exam or procedure, or the reason for your visit. A condition categorized as "medical" will usually be covered with standard health coverage. In certain instances, a routine exam may be upgraded to a medical visit.
General Health: Covers eye issues that fall under the category of general health, such as an exam that is deemed essential by a physician for a diabetic patient. Usually provides coverage for ocular disease, infections, eye issues, and other related conditions.
Post-Surgery Interventions: Some plans may provide free or reduced prices for prescription lenses following certain surgeries. An example of this would be a prescription for scleral contact lenses following a corneal transplant.
Health Savings Accounts (HSA) and Flexible Spending Account (FSA): These are types of flexible accounts where you decide upon a predetermined sum, which is automatically deducted from each paycheck to pay for health care items that aren’t normally covered by medical insurance. These include prescription glasses, sunglasses, contacts, saline solutions, and routine eye exams. An added benefit of these accounts is that the sum isn't taxed.

Use them or lose them!

FSA programs usually don’t roll-over annually, so you want to use up your benefits each year so you don’t lose them. The advantage of HSA programs is that they tend to roll over, so you retain your accumulated funds each year, with the advantage of being able to save up for more expensive products and services.

Vision Insurance

Vision insurance provides additional coverage for non-medical related vision care services that aren't covered under general medical insurance. The following factors are characteristic of many plans:

They sometimes require pre-approval. Typically, the policy provides specific and defined coverage for eye procedures and exams ("routine eye exams"), which are not covered under regular health plans.
Minimum monthly payments, although top-tier insurances can cost as much as $30 a month. High-tier plans may offer reductions for corrective surgery procedures.
The market offers competing programs with different benefits, in the form of fixed allowances for prescription lenses, contact lenses, procedures, exams, etc.

Common Questions

What is the difference between medical and vision insurance?

Vision insurance typically is used for eye exams, frames, lenses and contacts whereas medical insurance is generally used only for exams that have a medical nature such as dry eye or another medical diagnosis.

Does medical insurance cover everything that vision insurance does?

Vision insurance, which is really more similar to a discount program, covers a certain percentage of routine eye care expenses, for example an annual eye exam, an annual contact lens exam, and renewing your prescription glasses or contact lenses. Medical insurance usually covers expenses associated with any medical conditions related to your eyes or vision, but it generally does not cover routine care such as annual eye exams, eyeglass lenses, eyeglass frames and contact lenses. It's important to note that most vision insurance plans don't cover 100% of your vision expenses. As a result, you should expect some out-of-pocket expenses. In order to be familiar with your specific plan's details, we strongly recommend contacting your insurance provider before your appointment.

Do I Need Additional Vision Insurance?

Probably not. In most instances, you should NOT purchase extra vision insurance. Despite being marketed as such, most vision plans are not really an “insurance” plan but more of a type of discount program for eyewear and related products. Consider opening up a HSA or FSA type program with your regular medical insurance program, which enables you to save money for vision products and services that aren’t covered. In most instances, they are a superior option to cover the costs for vision care. Speak with your medical provider to find out what kinds of vision care is covered by your medical plan, and to find out more about HSA/FSA options.

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Testimonials

I haven't actually used the optometrist side, so my review is limited to the vision therapy offered. This office was recommended by my occupational therapist for the treatment of my double vision following a stroke.

Claire A.

Love this location. I had a brain injury accident from day one one. All the team make you feel you still important and hope in the horizon after when the medical system fell you miserably. Dr. Ikeda very professional and very understanding about your issue. Two tombs up.

Jim K.

My husband and I were immediately impressed with Dr Ikeda. I was hit by a car while cycling which caused broken bones and three brain injuries. The brain injuries caused double vision. Dr. Ikeda examined my eyes and got me started on vision therapy with his occupational therapist who specializes in vision therapy. She (Chris) is absolutely great. I am impressed with the array of tools used to help recover my binocular vision. I am doing things I never thought were possible (balance boards etc). Chris pushes me and keeps me motivated. I really enjoy my sessions with her. The office staff is always friendly and they have a wonderful appointment reminder tool that makes it easy to keep my calendar up to date. I am happy the rehab center at Little Co. of Mary recommended them!!

Teresa S.

The Vision Therapy is handled in a separate office through a different door from the shared waiting room. Chris, the vision therapist, has a wide and varied assortment of tools, equipment and resources to best evaluate and treat most vision issues. After just a few visits, my double vision became easier to control, using exercises developed during the therapy process. It was time well-spent.

Joe M.

I have been coming here since I can remember. I love it here. The staff is so amazing and nice. They explain everything they gonna do and never make you feel rushed. Dr. Ikeda has always been my doctor and I would never want another one. He is the doctor for my whole family and is always asking how everyone is doing. I am also so crazy about picking out my frames and have to try so many and each person who helps me take the time and lets me try them all on. I would never want to go anywhere else! I definitely would recommend this office to anyone looking for a great eye doctor.

Kayla W.

This is not for the eye exam but for the frames selection portion. I brought my prescription from Kaiser here with my VSP insurance. The reception staff was very polite and professional. Manny helped me to pick out frames and explain my coverage. Very helpful and patient not like the individual at the other place I rated here on Yelp. I was running late and he still helped me and was not bothered at all. I am so glad I came here ..........very pleased.

Very professional staff and pleasant.