Does Health Insurance Cover Eye Exams?

Medical insurance can be pretty confusing. Every policy is different and the services that are covered vary from plan to plan. Your best friend’s policy may cover specific medical care, but yours may not, and vice versa. Eye exams are one service that can vary greatly from insurance plan to insurance plan.

Whether you have worn glasses your entire life, your vision becomes skewed, or you just want to have your eyes checked out, you are probably wondering if your health insurance will cover the cost of eye exams. The answer to that question is: it depends.

Eye Exams and Health Insurance

does health insurance cover eye eamsJust like any other medical service that you might require, don’t assume that just because you have health insurance that eye exams are covered by your policy. As mentioned, the specific coverages offered by insurance plans do vary; moreover, coverage for the same policy can change over time. For example, your policy may have provided coverage for eye exams for years, but at the start of the new year, that may change.

Additionally, if your policy does offer coverage for vision exams, it may not cover all aspects; for instance, vision tests may be covered, but tests for certain conditions, such as glaucoma or treatment for chronic dry eye, may not be. That’s why it’s important to speak to your health insurance company on a regular basis to find out exactly what your policy covers. The last thing you want to have happened is to assume that your eye exam will be covered by your health insurance carrier, only to find out after you have had the service performed that coverage did not extend to certain elements – or to any of the exam.

Vision Insurance Explained

Your health insurance may provide coverage for certain types of vision exams, but not others; for example, it might offer coverage for medical exams, but not routine exams. For instance, if you are having your vision checked to see if it has changed and to get a new prescription, your health insurance may not cover your exam; but, if you are suffering from an ailment or an injury to your eye and require   a medical eye exam, your health insurance carrier might cover your examination.

If your health insurance does not offer coverage for medical or routine eye exams, you can purchase vision insurance, which is a supplement to your regular healthcare plan. With this type of supplemental insurance, you can have your vision health covered by your carrier; but, that’s not to say that all vision insurance policies are the same. Just like regular health insurance plans, vision policies vary.

Routine and medical eye exams, for example, vary from company to company, and health insurance companies may only provide coverage for one type of vision exam, not both. Typically, health insurance carriers handle medical eye exams and routine eye exams differently; for instance, your health insurance company may cover the cost of a medical eye exam, but it may not pay for a routine eye exam; in other words, if you are seeing an eye doctor because you believe you have conjunctivitis, your carrier will likely consider your visit a medical exam; but, if you are having a screening to diagnose farsightedness, it may deem the assessment as a routine eye exam, which may not be covered.

Finding a Vision Policy

There are various types of vision insurance policies, and, as mentioned, the coverage that these policies provide does vary. If you are investing in supplemental vision coverage, it’s important to find a policy that will work for your needs. For example, if you wear glasses or contacts, you will want to invest in a policy that will cover routine eye exams and even pay for part or all of your corrective lenses.

When shopping for vision insurance, make sure that you consider all of your specific needs. It’s also in your best interest to speak to an insurance agent that specializes in vision coverage. Vision insurance can be confusing and trying to navigate what is covered and figure out which policy will best meet your needs, it’s in your best interest to speak to someone who has experience and a firm understanding of this type of coverage.

The Bottom Line

The health of your eyes is crucial to your overall health and well-being. Routine eye exams assess your vision, while medical eye exams assess the health of your eyes and diagnose any medical problems that may exist (glaucoma, cataracts, etc). Some health insurance plans will cover medical eye exams, but not routine eye exams. To offset the cost of care, it’s a wise idea to speak to your health insurance company to find out if your policy covers eye exams, and if so, exactly what is covered. To ensure proper coverage, consider investing in a vision policy that includes both routine and medical eye exams.

Leave a Reply

Your email address will not be published. Required fields are marked *