What’s the Difference Between Medical & Vision Insurance?

Navigating medical and vision insurance can be confusing, especially when determining which plan covers different eye care. At Glimpse Eye Care, we help patients understand how their insurance applies to routine vision care, medical eye treatments, and specialty services. 

If you’re unsure whether your visit falls under vision or medical insurance, our team is happy to assist you in verifying your benefits before your appointment. 

senior woman patient talking with female ophthalmologist
man holding contact lenses

What Does Vision Insurance Cover?

Vision insurance covers routine eye care and corrective eyewear. This type of insurance typically includes: 

  • Annual or biennial comprehensive eye exams to check vision and update prescriptions. 
  • Eyeglasses and contact lens allowances, which help reduce costs for frames, lenses, and contacts. 
  • Lens enhancements, including anti-reflective coatings, blue light filters, and transition lenses.
  • Discounts on additional pairs of glasses or contact lenses. 

Vision insurance does not cover medical eye conditions, treatments, or emergency visits. Your medical insurance will likely cover your exam if it’s related to an eye disease, injury, or ongoing medical issue. 

What Does Medical Insurance Cover? 

Medical insurance applies to eye conditions that require treatment, ongoing monitoring, or urgent care. We will bill medical insurance—not vision insurance—if your visit is related to a medical diagnosis. Covered services may include: 

  • Diabetic eye exams and retinal screenings. 
  • Glaucoma diagnosis, testing, and treatment. 
  • Cataract evaluations and post-surgical care. 
  • Dry eye disease assessment and advanced treatments. 
  • Eye infections, injuries, and sudden vision loss. 

If you need treatment for an eye condition rather than a routine vision check, your medical insurance may help cover your visit and any necessary procedures. 

man rubbing eyes
doctor and patient

How to Determine Which Insurance Will Be Used

Insurance billing depends on the reason for your visit: 

  • If you are visiting for a routine eye exam to check your vision and update your prescription, vision insurance will apply. 
  • If you have a medical eye issue, such as dry eye, glaucoma, or diabetes-related vision changes, your medical insurance will be billed. 
  • If your visit includes both a medical evaluation and a vision check, you may submit separate claims to both plans. 
  • If you are unsure which plan applies to your visit, our team can help you understand your coverage and verify your benefits. 

Maximizing Your Insurance Benefits  

To make the most of your coverage: 

  1. Schedule your annual eye exam before your benefits reset. 
  2. Use your frame and lens allowance to invest in high-quality eyewear. 
  3. Apply HSA/FSA funds for prescription glasses, contact lenses, and dry eye treatments. 
  4. Take advantage of any discounts on second pairs of glasses or specialty lens options. 

Understanding your vision and medical insurance coverage helps you avoid unexpected costs and ensures you receive the best possible eye care. 

ophthalmologist doctor and patient