Vision and Medical Insurance

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Despite being marketed as such, most vision plans are not really an “insurance” plan but more of a type of discount program for eyewear and related products.

Many people become flustered when trying to decide if purchasing extra vision insurance is a viable option for them.The following article addresses the differences between medical insurance and vision insurance, and what they generally provide coverage for.

Our eye doctor has extensive experience in helping people with their questions about different insurance options. To find out more about the available options, you can reach out to your nearest Amplify EyeCare practice either via a call or in-person visit.

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What is the Difference Between Vision and Medical Insurance?

The differences between the kinds of benefits that vision and health insurance each provide, aren't always clear. Being that many aspects of eye care are not covered with standard medical coverage, it is important to know the differences. The following article will explain the benefits of each type of insurance. Depending on your individual needs you will be able to decide if you require extra coverage.

Medical Insurance

Medical Insurance

Regular health insurance provides overall care for eye damage or disease, but doesn't cover routine eye exams, eyeglass frames, or prescription lenses for glasses or contacts. Certain ocular exams and procedures may be covered depending on the following:

  • How A Visit Is Defined: Coverage depends on how a doctor defines an exam or procedure, or the reason for your visit. A condition categorized as "medical" will usually be covered with standard health coverage. In certain instances, a routine exam may be upgraded to a medical visit.
  • General Health: Covers eye issues that fall under the category of general health, such as an exam that is deemed essential by a physician for a diabetic patient. Usually provides coverage for ocular disease, infections, eye issues, and other related conditions.
  • Post-Surgery Interventions: Some plans may provide free or reduced prices for prescription lenses following certain surgeries. An example of this would be a prescription for scleral contact lenses following a corneal transplant.
  • Health Savings Accounts (HSA) and Flexible Spending Account (FSA): These are types of flexible accounts where you decide upon a predetermined sum, which is automatically deducted from each paycheck to pay for health care items that aren’t normally covered by medical insurance.  These include prescription glasses, sunglasses, contacts, saline solutions, and routine eye exams. An added benefit of these accounts is that the sum isn't taxed.

Use them or lose them! 

FSA programs usually don’t roll-over annually, so you want to use up your benefits each year so you don’t lose them. The advantage of HSA programs is that they tend to roll over, so you retain your accumulated funds each year,  with the advantage of being able to save up for more expensive products and services.

Vision Insurance

Vision Insurance

Vision insurance provides additional coverage for non-medical related vision care services that aren't covered under general medical insurance. The following factors are characteristic of many plans:

  • They sometimes require pre-approval. Typically, the policy provides specific and defined coverage for eye procedures and exams ("routine eye exams"), which are not covered under regular health plans. 
  • Minimum monthly payments, although top-tier insurances can cost as much as $30 a month. High-tier plans may offer reductions for corrective surgery procedures.
  • The market offers competing programs with different benefits, in the form of fixed allowances for prescription lenses, contact lenses, procedures, exams, etc.
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Common Questions

Vision insurance typically is used for eye exams, frames, lenses and contacts whereas medical insurance is generally used only for exams that have a medical nature such as dry eye or another medical diagnosis.
Vision insurance, which is really more similar to a discount program, covers a certain percentage of routine eye care expenses, for example an annual eye exam, an annual contact lens exam, and renewing your prescription glasses or contact lenses. Medical insurance usually covers expenses associated with any medical conditions related to your eyes or vision, but it generally does not cover routine care such as annual eye exams, eyeglass lenses, eyeglass frames and contact lenses. It's important to note that most vision insurance plans don't cover 100% of your vision expenses. As a result, you should expect some out-of-pocket expenses. In order to be familiar with your specific plan's details, we strongly recommend contacting your insurance provider before your appointment.
Vision and Medical Insurance
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Do I Need Additional Vision Insurance?

Probably not. In most instances, you should NOT purchase extra vision insurance. Despite being marketed as such, most vision plans are not really an “insurance” plan but more of a type of discount program for eyewear and related products. Consider opening up a HSA or FSA type program with your regular medical insurance program, which enables you to save money for vision products and services that aren’t covered.  In most instances, they are a superior option to cover the costs for vision care. Speak with your medical provider to find out what kinds of vision care is covered by your medical plan, and to find out more about HSA/FSA options.

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