Vision Insurance

Vision insurance is usually optional coverage added to your insurance package that covers 'routine' eye wellness exams. This insurance may or may not include allowances or coverage for spectacles, lenses, or contact lens related fees. The plans normally allow for an 'eye exam' once per calendar year, although plans vary. Examples are OptumHealth Vision, Spectera, VSP.

Medical Insurance

An optometrist is a medical specialist (optometric physician) and most optometrists participate as providers for care which is covered by your medical insurance. Because an optometrist is an “eye specialist”, these exams are covered much like a visit to any specialist, like a cardiologist or allergist. Medical Insurance Companies will typically pay for an eye exam where there is a medical diagnosis (for example, allergies, pink eye, headaches, diabetes, eye infection, glaucoma suspect, at-risk for future eye problems). Sometimes, a medical insurance company will require a referral to come see an optometrist (because they are eye specialists, just like cardiologist and allergists are specialists). The patient is responsible for finding out if a referral is needed, and this must be obtained by the day of the eye exam.

If there is a medical necessity for the exam, then usually most of the exam fees will be covered by your medical insurance--regardless of whether or not you have a vision plan or "vision insurance." If the doctor finds that there is nothing medically wrong, the insurance company may not pay for the exam, and payment will be the responsibility of the patient. "But my insurance only covers an eye exam once a year." This statement is referring to the vision care policy, and your 'vision' wellness exam (as described above). Medical eye care, like any other 'specialty,' is covered as often as is seen fit by the physician.