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. Schedule an appointment today to find out more about the available options.

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

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 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.

Common Questions

What is the difference between medical and vision insurance?

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.

Does medical insurance cover everything that vision insurance does?

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.

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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Testimonials

Such a nice optician. My grandson is only 4 and needs glasses. We were so sad, but he explained the issues, and we will follow up as he suggested.

Anna P.

I had such a good experience with the clinic. Very friendly staff and doctor, did not have to wait for long to be called, and was treated respectfully. Thanks, American Family.

June S.

Dr. Zurcher has gone above and beyond what any other eye doctor has ever done to figure out what is going on with my eyes. Very happy with American Family Vision.

Christine R.

Family Vision Clinic changed our lives! My daughter was frequently car sick, and she was getting headaches every day, often painful enough that they brought her to tears. We saw a string of doctors and therapists, but we made no progress. Finally, we found Dr. Levi Zurcher and his eye therapist Rain. After ten weeks of eye therapy my daughter no longer gets headaches, and she no longer gets car sick. Daily tears are a thing of the past. I really can’t say enough about this clinic. It was fascinating to watch Dr. Zurcher work. For the first time, someone who knew what they were doing was intently studying my daughter, really trying to figure out all of her eye issues, and his therapist Rain is one of the most patient and lovely people that I’ve ever had the good fortune to meet. We’re finished with eye therapy—yay!—and I have switched to American Family Vision Clinic for all of my family’s other eye health needs.

Lars Wulff

Very professional, yet kind and helpful. They do what they can to make the appointment comfortable. I was running a bit late, I made sure ti call. They were able to switch me with a patient who was already there, they treated me with respect, and helped my son have confidence by getting him the eye care he needed that day. Thank you so much! Would recommend to anyone. It's a blessing that they care enough to work with people who have all different types of insurance from work to state coverage.