Medical vs. Vision Insurance: Making Sure Your Treatment Is Covered

We receive questions about insurance on a daily basis, with one of the most common questions being what the difference is between medical and vision insurance. Since this topic tends to confuse so many patients, our team at TRES VISION Group in Melbourne, FL thought it would be a good idea to differentiate your two policies when it comes to eye care.

What Is Covered by Vision Insurance?

Standard optometry appointments are not generally covered by medical insurance plans. If you have a refractive error like nearsightedness, farsightedness, or astigmatism, it generally makes financial sense to have vision insurance to help cover costs on annual eye exams, contact lenses, and eyeglass frames.

Be aware that most vision insurance plans still require you to pay some out-of-pocket expenses and co-pays. More expensive policies may cover more advanced lenses like transition lenses or lenses with scratch-resistant coating. Although LASIK is not covered by most vision insurance plans, some do offer discounts.

What Is Covered by Medical Insurance?

Medical insurance is usually applied to eye issues not related to your prescription. Almost any issue that poses a threat to your eye’s health is covered by your health insurance. Diseases and conditions such as cataracts, glaucoma, macular degeneration, keratoconus, diabetic retinopathy, and dry eye all fall under that umbrella. The same goes for medical emergencies (such as a traumatic injury to your eye) or vision impairment that is the result of a medical condition like diabetes or heart disease.

Can You Combine Both Forms of Insurance?

Although some ailments may seem like they could be covered by both forms of insurance, we cannot legally file a claim for a single appointment to two different insurance companies. If you are unsure which type of insurance applies to your situation, we encourage you to bring all relevant insurance cards to your appointment so that we can help you file the claim that will be most financially advantageous to you.  Based on the reason for your visit, the doctor will determine if it should be billed under your vision or medical insurance.

Speak to the Team at TRES VISION Group

Insurance policies are rarely as simple as we wish they were, but to recap briefly, your vision insurance covers standard eye care like examinations and prescription lenses, while medical insurance deals with most other eye issues.

At TRES VISION Group, we accept a long list of major insurance plans. Better yet, our team will go the extra mile to help you understand your individual policies so that you receive the maximum benefits you are entitled to. Don’t let confusing policies prevent you from seeking standard eye care, including annual examinations. Our eye doctors are eager to help you maintain clear vision and healthy eyes. Call (321) 984-3200 to make an appointment.