Medical insurance for your overall health is different from vision insurance for eye health. It’s one of the more confusing issues facing patients when they visit their eye doctor. In a nutshell, vision insurance only covers updates in glasses and contact lens prescriptions, as well as an annual health wellness screening.
It does NOT cover any other issues affecting the eye, such as dryness, infections or allergies. Other conditions it does not cover include:
- Treatment for headaches
- Macular degeneration
- Monitoring for those on high-risk medications
- Diabetes check-ups
In order to get coverage for these conditions and treatments, you would have to turn to your medical insurance.
That being said, the language governing insurance benefits and healthcare coverage isn’t always clear. It’s wise to speak with a benefits specialist or human resources representative from your company to learn exactly what is covered and what is not. Keep these general things in mind about vision insurance vs. health insurance.
Breaking it Down
There are certainly many options available to patients when it comes to vision insurance providers. However, each one has its own specific coverage benefits and amounts that you should check on before making an appointment. Generally, they cover routine care such as annual exams, glasses and contact lenses.
Your entire exam, glasses or contacts may be covered by your vision insurance, or depending on your plan, they may pay a portion and you have to shell out the rest. Most vision providers cover the entire exam for a wellness check if you schedule it on their timeline, such as once yearly or once every two years. If you go more frequently than that, they may pay nothing or just a portion.
When it comes to contacts and glasses, you usually have to pay a co-pay or a percentage of the total cost if you choose eyewear out of their allowable price range.
So, what’s the difference between this and health insurance? Well, health insurance typically covers eye care that relates to a medical condition. If you require an eye exam due to cataracts, dry eyes, diabetes or high blood pressure, your medical insurance will cover this, not your vision care provider.
Health insurance will also cover care that arises from an eye injury or eye disease.
It’s always wise to have vision insurance in addition to health insurance because it saves you a lot of money on eye care and exams. Plus, the plans are pretty inexpensive. Having this coverage also keeps you accountable for scheduling your annual exams so you don’t forget.
It’s best to talk to your employer and ask them questions about health care coverage or vision benefits that they provide you. Then, contact an eye care professional to ask if your vision benefits are accepted, as well as how you can use those benefits to save money on your next exam or eyewear purchase.
Contact Simon Eye Associates
You will be glad to know that Simon Eye welcomes most insurances and vision plans. Plus, we have affordable eye care options for patients who have no insurance. To learn more, contact us at 302-239-1933.