Medical vs. Vision Insurance: What You Should Know

The benefits of medical insurance are clear to most people. However, what about vision insurance — is it really necessary? The short answer is that many people will find additional value in vision insurance.

Differentiating between medical and vision insurance can be tricky or confusing for some people, especially since vision insurance is often used as a supplement to a regular health insurance. To help you understand the difference between vision and medical insurance, vision and eye specialist Downtown Eyes shares more information below. We also discuss some essential details that you should know about vision insurance.

Medical Insurance vs. Vision Insurance

To distinguish medical and vision insurance, the main factors to consider are the type of eye exam that you will undergo and your reason for visiting an eye doctor. Typically, visits to an eye care professional are categorized as either “routine” or “medical.” However, this does not necessarily inform the steps that your doctor will take to perform the eye exam. A comprehensive “routine” vision exam may contain the same elements as a comprehensive “medical” eye exam. Also, the type of doctor you see for your eye exam doesn’t typically impact the type of insurance coverage you need. For example, if you see an ophthalmologist, the exam is not necessarily classified as medical in nature.

The reason for your visit is important in determining the type of coverage you need, as is your diagnosis. For example, routine vision exams can lead to diagnoses like astigmatism or nearsightedness, while medical eye exams can result in diagnoses such as conjunctivitis.

What About Vision Discount Plans?

You may also have heard about vision discount plans. Take note that these are different from vision insurance since a vision discount plan can only offer discounts on vision care. Vision discount plans are usually cheaper than vision insurance. When choosing between vision insurance and a vision discount plan, it’s important to consider how often you need eye exams or new lenses. For example, you may benefit more from vision insurance if you visit an eye clinic regularly, you’re at risk of developing eye diseases or require preventive care and corrective lenses.

Understanding Your Coverage

If you have both medical insurance and vision insurance, it’s important to have a good understanding of each plan can provide you. Make sure that you are familiar with how your insurance company handles routine eye exams and medical eye exams. For example, your medical insurance may cover a medical eye problem, but it may not pay for a routine eye exam. In other cases, your vision insurance may cover your glasses and contact lenses, or your medical insurance may only pay for exams if you have eye health problems

Clearly, this is a complex issue that can be confusing, so you should study your medical and/or vision insurance plan closely. Insurance coverage usually varies among insurance companies, so it’s best to have a thorough discussion with your insurer. If there are details that seem vague to you, don’t hesitate to point them out and ask for clarification.

Also, keep in mind that although many eye care practices are familiar and knowledgeable about insurance plans, it is not their responsibility to know the full details of your policy. Ensure that you are aware of possible deductibles and co-pays. For example, your insurance may cover routine eye exams, but you might still need to pay out of pocket if your deductible has not been met. Ask your insurer about a variety of possible scenarios so that you can have a better grasp of what to expect during these exams. This will also help you maximize the benefits that you can get from your insurance plans.

Sample Scenario

To give you a clearer idea of how vision and medical insurance usually work, here’s a real-life example that you can refer to.

Let’s say you have both types of insurance: medical insurance and a separate vision insurance plan. Let’s say you decide to visit your doctor for your annual eye exam. Your glasses have been damaged, so you need a new pair. At the clinic, your eye care professional performs a routine eye exam, during which they determine that you need a minor prescription change and that you also have signs of glaucoma. You are then instructed to return to the clinic in one week for additional tests.

Since your original reason for the first visit was to have an eye exam and purchase new glasses, these things will be covered by your vision insurance — even though your doctor found signs of glaucoma during the examination. Your medical insurance will only start to kick in when you return for the additional tests and consultations related to your doctor’s medical diagnosis of “glaucoma suspect.” For your eye exam the following year, since you have been determined to be at risk for developing glaucoma, your medical insurance plan will likely cover your appointment.

What Does Vision Insurance Cover?

Vision plans typically pay a portion of basic preventive care such as vision tests and contact eye exam, eyeglass lenses, eyeglass frames, contact lenses and lens protection for glasses like scratch-resistant coating. Vision insurance may also offer additional coverage such as discounts on corrective eye surgery like LASIK and daily disposable contact lens coverage.

That’s only a general sense of what vision plans and vision insurance cover. To get the full scope of coverage of your insurance, you should refer to your policy.

Who Needs Vision Insurance?

Anyone can benefit from vision insurance since eye exams are quite helpful in the detection of hidden medical problems. That’s why even if you currently have perfect vision, it doesn’t hurt to know your options and prepare for your eye care needs as early as now. As you age, you may find yourself in need of more frequent eye exams.

For example, people aged 20-39 are recommended to visit their eye doctor every five to 10 years. People aged 40 to 54 should have their eyes checked every two to four years. Adults ages 55 to 64 should have eye exams every one to three years, and people aged 65 and above should have office visits every one to two years.

Vision insurance can also be beneficial to people with poor vision or a family history of eye disease or a condition that could potentially increase the risk of eye disease (diabetes, for example). However, if you simply need routine exams, getting vision insurance might not be worth it. But if you do need corrective lenses in addition to preventive care, you should definitely consider getting vision insurance.

Schedule an Appointment Today

If you’re looking for quality eye care services, there’s no need to look further than Downtown Eyes. Our staff consists of highly trained and experienced professionals who can ensure an exceptional experience for you. Our areas of expertise include eye exams, contact lenses, eyewear, dry eye treatment, red eye or pink eye, computer vision syndrome and other common eye problems. To learn more about our services, you can call us at (612) 333-EYES (3937) or fill out our contact form.