Medical vs Vision Insurance Explained

What is Vision Insurance, and how is it different from Medical Insurance?

A Vision "insurance" plan is different from your health insurance policy & should really be considered as a Vision Benefit Manager or Vision Discount Plan that serves as an intermediary to administer the discounts associated with routine vision exams, prescription eyewear & contact lenses..

How are Vision Discount Plans different from Medical Insurance?
A Vision Discount Plan is different from your health insurance policy. Regular medical health insurance protects you from costs from eye diseases or eye injuries. In contrast, Vision Discount Plans provide an added wellness benefit for healthy eye exams, which includes routine eye care, prescription eyewear and contact lenses, and other vision services at a reduced cost.

What does Vision insurance cover?
Most Discount Vision Care Plans include the following benefits:

• Annual vision exams

• Eyeglass frames

• Eyeglass lenses

• Contact lenses

Some examples of Vision Discount Plans include VSP, Eyemed, Spectera, Superior/Davis Vision. However, we do not participate in every Discount Vision Plan. In the near future, we intend to offer our own in house Vision Discount Plan.

We assist in verifying your benefits before your appointment & can confirm with your plan to see if your benefits cover you once every year or once every two years. Eyeglass frames and lenses and contact lenses can usually be purchased at a discount, but not every plan has this benefit.

Prior to your visit, please make sure you are familiar with the optical benefits offered by your vision insurance. During your appointment, you will be presented with some options for purchasing prescription eyewear. Payment will be due in full at the time of your order, which means any costs above your insurance coverage will be your responsibility.

What does my Vision Discount Plan NOT cover?
Vision Discount Plans do not cover any part of an eye exam considered "medical". For example, Vision Discount Plans will not cover exam visits that offer treatment plans associated with vision loss, dry eyes, allergies, infections, glaucoma, cataracts, macular degeneration, new onset of floaters, or eye exams related to diabetes management. As a general rule, if you need medication as part of your treatment plan, the doctor's office staff will be billing your medical insurance & you will not be able to use your Vision Discount Plan for that visit.

When you call to make your next appointment with the eye doctor, make sure to explain the purpose of your visit so that we bill the appropriate insurance. Additionally, please always bring your medical insurance card(s) with you to every appointment.

What is a Refraction?
A refraction is when your eyes are checked to see if you need a new eyeglass or contact lens prescription. In general, health insurance won't cover the fee for the refraction (estimated cost of $40), which is a procedure that is separate from your eye health exam.

Can I use my vision insurance and my medical insurance for a joint exam on the same day?
No. By law, we cannot bill two different types of insurance on one day for the same service. In many situations, we will schedule your medical and vision visits on separate visits, allowing us to bill your Vision Discount Exam for the refraction & screening for any eye disease. whereas your Medical Insurance would be used for the visit that is specific for ocular disease management. You may have to go through some repetitive parts of the exam on those days because of insurance regulatory matters, as there are certain things the eye doctor must document at every visit. However, there are some situations in which the Vision Discount Plan will allow us to file for a coordination of benefits between the Medical Insurance & the Vision Discount Plan. Your Vision Discount Plan will cover the refraction, but not the ocular health assessment of the exam if you are having a medical problem.

Will Medicare cover my Refraction for new glasses or contact lenses?
Unfortunately, no. Medicare does not cover Refractions in which your glasses or contact lens prescription is checked. Medicare will pay for the ocular examination & special testing necessary to monitor eye disease and other problems relating to medical concerns of the eyes.

Why is insurance so complicated?
Good question! We don't make the rules, we just follow them. You can call the phone number on the back of your insurance card or look up your insurance policy details online. Ultimately it is your responsibility to understand the policy of your Medical Insurance your Vision Discount Plan. However, for our established patients with a specific Recare treatment plan, we will always prepare a Good Faith Estimate for the services planned for your next visit. In summary, traditional medical health insurance protects you from any costs from eye diseases or injuries. In contrast, Vision Discount Plans provide an added wellness benefit for healthy eye exams, which includes routine eye care, prescription eyewear and contact lenses, and other vision services at a reduced cost.