The topic of insurance has always been confusing, especially when it comes to eye care. When an eye exam covered under vision insurance benefits and when it is covered by medical insurance has been a frequently asked question. To help you, your optometrist will explain each option’s inclusions and exclusions:
With the Affordable Care Act, having a medical insurance is now a requirement in the U.S. Medical insurance covers eye care services you’ve received that are “medical” in nature. These include eye exams when your chief complaint is eye infection, swelling or other similar problems. Emergency visits to the hospital because of a specific eye concern would also be covered under your medical insurance.
Other instances when your appointment with your eye doctor may be billed with your medical insurance is when your undergo procedures for cataract or glaucoma management. The same goes for diagnostic procedures to confirm floaters or retinal tears. As long as there is a medical diagnosis, the payment will be expected from your medical insurance.
Unlike medical insurance, not all are expected to have vision insurance. Most of the time, it is an add-on benefits or supplemental to your medical health insurance. Vision insurances are considered vision benefits as they are primarily created to pay toward your routine or preventative eye products and services.
If you had an eye exam just to make sure that your eyes are healthy and there are no medical problems, then the eye assessment will be covered by your vision insurance. Apart from routine eye exams, vision insurances may also give you a discount on eyeglasses or contact lenses. Keep in mind, however, that special coatings or lenses, as well as elective procedures like LASIK, are often not included benefits under vision insurances.
Should it happen that you went to your eye center to have your routine eye exam and a vision problem that is medical in nature was found, it’s still possible that the eye exam itself will be covered by your vision insurance. That said, diagnostic procedures or treatments to manage the identified eye condition will most likely be covered by your medical insurance.
For more information on vision care, call us at (717) 609-4443 or complete our form. We serve Chambersburg and nearby PA areas.