Insurance can help take a load of stress off your shoulders when it comes to paying for your family’s healthcare. However, having multiple insurance plans can be a little tricky to manage—especially if you have medical and vision plans to help cover your eye care needs.
Everybody’s insurance plans are a little different, but there are distinct differences between vision and medical insurance you should know about before you book a comprehensive eye exam or start treating a specific eye disease. Today, we’ll look at these differences so you can use the right insurance plan for your needs and get the care you deserve.
We always recommend speaking to your insurance company for direct details regarding your plan but feel free to reach out to us if you have any questions or concerns. Our team is always ready to help!
When Can You Use Your Insurance?
You can use your insurance plans for any services that fall under what the plan covers. However, the tricky part here is that several factors can change what your insurance is willing to cover. Some factors that can affect what your insurance covers include:
- If your optometrist is part of your insurance’s network
- The types of services you get
- Your lens prescription
- Your eyeglasses and materials
- Contact lenses
Vision insurance may be a part of your overall healthcare plan, but this might not always be the case. It’s always important to speak with your insurance plan to see what is covered before you start looking for services.
Medical insurance is designed to cover the medical costs of your eye care. For example, medical insurance may help cover the costs of:
- Medically-related eye exams (no refraction exam)
- Emergency eye exams and eye care
- Eye disease treatment and management
- Diabetic eye health concerns
- Infections and allergies
On the other hand, vision insurance covers the more “routine” aspects of eye care. These can include:
- Refraction exams (nearsightedness, farsightedness, astigmatism)
- Lens prescriptions, frames and contact lenses.
- Contact lens exam
How much your plan will cover may depend on your insurance plan. In some cases, they may only cover partial costs of these services, meaning you will need to pay for the rest out-of-pocket.
Vision Insurance vs. Medical Insurance
A vision exam is recommended every year. This exam will screen for eye diseases and provide measurements for eyewear and/or contacts.
Reasons for a Vision Exam:
- Blurry vision
- Trouble reading up-close
Diagnosis Reasons for Vision Exam:
- Routine eye wellness
- Myopia (nearsighted)
- Hyperopia (farsighted)Presbyopia (bifocal age)
A vision exam is covered by vision care plans. If abnormal findings are discovered during your routine eye exam, you will be asked to return for additional testing and evaluation which will be billed to your medical insurance.
- Vision plan copay
- Contact lens fit fee (may be filed to your vision plan depending on the policy)
- Possible follow-up visits when medically necessary
A medical exam is performed to evaluate abnormal findings and monitor existing medical conditions.
Reasons for a Medical Exam: Any disease or abnormality that could result in a decline of vision that is not prescription related.
Diagnosis Reasons for a Medical Exam:
- Macular Degeneration
- Retinal Disorders
- Plaquenil/Macula monitoring
- Eye infections
- Dry eye
- Eyelid disorders
- Eye injuries
A medical exam will be billed to your medical insurance.
- Medical insurance copay
- Co-insurance and insurance deductibles
- Refraction fee
- Contact lens fit fee (if applicable)
What Is Still Out-of-Pocket?
There might be several different services and fees you might need to pay for out-of-pocket, and one of the most common include copayments.
Copayments are a fixed amount of money you pay for specific services while your insurance company covers the rest. For example, you might need to pay a $10 copayment fee for having a comprehensive eye exam, or you might need to pay a $20 copayment fee when you pick up any medications you may use to manage an eye condition or disease.
Aside from copayments, other out-of-pocket expenses can include:
- Contact lens fees
- Additional costs for frames and lenses, including repairs
- Specialty services, like laser eye consultations and dry eye treatments like IPL
However, your insurance plan might have specific rules on what is and isn’t considered an out-of-pocket expense. Please make sure you speak with them before your appointment with us to get a full picture of what your plan covers.
What to Bring to Your Appointment
Before you come in for your appointment, ensure you bring your medical insurance card and, if possible, your vision insurance card. Depending on the services we provide, we may use both your vision and medical plans to help cover the cost of your appointment.
If you only have one type of insurance plan, you’ll need to pay for certain services out-of-pocket. For example, if you don’t have medical insurance, your vision insurance may only cover the costs of a refraction exam and the partial cost of your eyeglasses.
If you’re confused about what to bring to your appointment, please call our team today.
What if You Don’t Have Insurance?
If you don’t have insurance, you will either pay full price for your services or turn to healthcare credit programs to help manage your costs. These credit programs offer flexible financing options with low interest rates that can help pay for eye exams, eye disease treatments, or surgeries.
Visit the LaFerla Team Today
Providing for your family’s eyes also ensures our services and support are as transparent as possible. If you’re wondering what services may fall under your vision or medical insurance plans, please speak with our team today before booking an appointment.
However, please speak with your insurance provider for the most comprehensive understanding of your insurance plan and what it covers.