Vision Insurance vs. Medical Insurance

Our goal is to help you better understand the difference between vision and medical insurance so you can feel more prepared before your appointment.

See Accepted Insurances

What Is the Difference Between Vision and Medical Insurance?

Imagery of a patient choosing prescription glasses.

Vision and medical insurance can both help cover the costs of eye care, but they generally cover different types of services.

Vision insurance typically includes benefits for routine eye care, such as eye exams that assess your vision and determine if you need glasses or contact lenses.

In contrast, medical insurance is usually utilized when an eye exam, testing, or treatment is necessary due to an eye disease, injury, symptoms, or another medical condition.

The type of insurance you should use for your visit often depends on the reason you scheduled the appointment and what your eye doctor discovers during the examination.

Insurance Comparison

Depending on your specific plan, vision benefits may help cover routine eye exams, refraction to determine your glasses prescription, prescription eyeglasses, eyeglass frames and lenses, contact lenses and contact lens evaluations or fittings.

Medical insurance is generally used when your visit is related to a medical condition, eye disease, injury, or symptom. Example: cataracts, glaucoma, AMD, eye injuries. Medical insurance may also be used for diagnostic testing, ongoing management of eye diseases, surgical care, and follow-up appointments when covered under your specific health plan.

Vision (Routine) Eye Exam vs. Medical Eye Exam

The difference between a routine eye exam and a medical eye exam generally comes down to the primary reason for the visit and the care provided. In some situations, a medical condition may be identified during an exam that was originally scheduled as routine vision care. How the visit and any additional services are billed can depend on the circumstances, services provided, insurance requirements, and your specific coverage.

Learn The Difference Need Assistance? (928) 445-1234

What Is a Refraction?

A refraction is a crucial part of an eye exam that determines your prescription for glasses or contact lenses. During this process, your eye doctor will compare various lens options to identify which prescription offers the clearest vision.

Refraction is typically included as a benefit in vision plans. However, it may not be covered by many medical insurance plans, even if it is performed during a medical eye exam. If your medical insurance does not cover the cost of refraction, you may need to pay for this service out of pocket.

Since insurance plans can vary significantly, it’s best to confirm your specific benefits prior to your appointment.

refraction test for a senior man as an eye doctor performs a slit lamp and refraction exam at M&M Eye Institute

How Can I Use Insurance for My Eye Exam?

You can have a comprehensive eye exam covered by your medical insurance, but it will not provide a prescription for corrective lenses. If you need both an exam for an eye condition and a wellness exam with refraction, you may need two separate appointments, as both insurances cannot be billed together. To avoid two appointments, you can pay out of pocket for the refraction and prescription.

If you want a routine eye exam and refraction through your vision insurance, make sure to do both on the same day to avoid separate payments.

Vision & Medical Insurance FAQs

If you’re experiencing symptoms, eye pain, vision loss, or have a diagnosed eye condition, medical insurance is typically used. Routine eye exams and glasses prescriptions use vision benefits.

No. By law, both insurances cannot be billed for the same visit. Patients may choose to pay out of pocket for refraction during a medical visit if needed.

Medical insurance does not cover glasses or contacts unless you use an HSA or FSA.

Refraction is the part of the exam that determines your glasses or contact lens prescription. This service is covered by vision insurance but not medical insurance.

Yes. Medical eye care and routine vision care serve different purposes. Your provider may recommend both depending on your eye health.

We accept many major vision plans. Please visit our Accepted Insurance page or contact our office to confirm your specific coverage.

Contact Us – Our scheduling team can help guide you based on your symptoms and goals for the visit.

Understanding Your Insurance Benefits Before Your Eye Exam

If you have any further questions about which insurance benefit to use for your eye exam, please ask our patient care representatives during scheduling or call us at (928) 445-1234. We also recommend contacting your insurance provider to ask questions, too.

See Accepted Insurances Contact Us