Trying to figure out whether you need to use medical or vision insurance for eye care can be confusing. Should you use your vision benefits for an eye exam? What about medical insurance for an eye condition? Knowing how these two types of insurance work can help you maximize your benefits and avoid unexpected costs.
At Ideal EyeCare in Council Bluffs, IA, and Omaha, NE, we accept most major vision and medical insurance plans. Let’s take a look at what each type of insurance covers and when you’ll need to use them.
What does vision insurance cover?
Vision plans focus on routine eye care and eyewear. If you wear glasses or contact lenses, vision insurance helps make your yearly exams and new eyewear more affordable. Most vision plans cover regular eye exams, which are important for keeping your prescription up to date and checking your overall eye health. They also typically offer an allowance for glasses or contact lenses, along with discounts on upgrades like anti-reflective coatings or progressive lenses.
What does medical insurance cover for eye care?
Medical insurance applies to eye care when it involves an injury, disease, or other medical conditions affecting vision. You’ll likely use medical insurance if you need:
- Treatment for Eye Infections or Injuries – If you have an eye infection, foreign object in the eye, or injury, medical insurance covers treatment.
- Care for Eye Diseases – Conditions like glaucoma, macular degeneration, or diabetic eye disease fall under medical insurance.
- Dry Eye & Other Medical Conditions – Medical insurance often covers exams and treatment for dry eye, cataracts, or other chronic conditions.
- Sudden Vision Changes or Eye Pain – If you experience blurry vision, double vision, or eye pain, a medical exam is necessary.
- Eye Surgery – Procedures such as cataract surgery or other necessary medical treatments are covered under medical insurance.
Essentially, if your visit is for a medical reason rather than a routine eye exam, medical insurance will be billed instead of vision insurance.
How to know which insurance to use
The type of insurance used depends on why you’re visiting the eye doctor. If you’re here for a routine eye exam, updating your glasses prescription, or using an eyewear benefit, you’ll use vision insurance. But if you have an eye infection or need treatment for an eye disease, medical insurance will apply.
In some cases, you may use both types of insurance. For example, if you’re being treated for glaucoma, your medical insurance covers the treatments. However, you may use vision insurance for new glasses if your prescription changes due to vision loss caused by glaucoma.
Maximize your benefits at Ideal EyeCare
Understanding your insurance can help you get the care you need without unexpected costs. If you have any questions or would like to schedule an eye exam in Council Bluffs, IA, or Omaha, NE, give us a call today at Ideal EyeCare!
