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Insuring My Vision

Most people require some kind of eye care throughout their lifetime, but how do they pay for it? Insurance can be a confusing topic in any circumstance but this is especially true when it comes to our eye health. Insurance for eye health care can come from various sources. It may be employer-sponsored medical or vision insurance, individually purchased medical or vision insurance, Medicare, Medicaid, state children’s health insurance programs, or other public or private programs. There are many distinctions between insurance plans, so check your plan documents carefully to determine what is covered, how often, and what your associated out-of-pocket costs may be.

Medical Insurance vs. Vision Insurance

Vision insurance and medical insurance cover different services, but the distinction can be confusing. Medical insurance (also commonly called “health insurance”) offers coverage for most services related to the health of the eye itself when provided by an eye care professional. For example, exams and tests associated with diagnosed cataracts, glaucoma, diabetic eye disease, and other conditions that require specific counseling, documentation, follow-up care, regular monitoring and/or referral to a surgeon, would be covered by your medical insurance. While many plans do not cover routine exams to determine if there is an eye problem in the general population, some may include regular dilated eye exams to check for signs of disease in individuals at high risk. However, there is a growing trend among medical insurance plans to cover a routine eye exam, so be sure to check with your insurance carrier about your plan’s benefits. Medical insurance does not cover routine eye care related to refractive error to determine your eyeglass or contact lens prescription. It also does not generally cover the costs of eyeglasses or contact lenses. Vision insurance is often sold as a supplemental insurance product to cover the cost of routine eye care. This generally includes a comprehensive eye exam, any associated refraction fee to determine your eyeglass prescription, and some allowance for glasses or contact lenses. A contact lens exam may be covered.

Which Insurance Will Cover My Eye Care?

Both vision and medical insurance can be used in our office, but which insurance plan pays for your eye care generally depends on the reason for your visit. If your diagnosis for the visit relates to refractive error, such as astigmatism, nearsightedness, or farsightedness, it will be covered by your vision insurance. If the diagnosis for the visit relates to glaucoma, cataract, conjunctivitis, or other
conditions that require medical care, it will be paid for by your medical insurance. “Medical care” in this case can be offered by any provider licensed to provide that care in your state; this usually includes both optometrists and ophthalmologists.

What If I Don’t Have Health Insurance?

There are many options for health insurance for your family. If you are unemployed, or if your employer does
not offer health insurance, you may be eligible for subsidies to help you pay for insurance offered through the health insurance marketplace in Alabama. Based on your household income, your child may be eligible for
Medicaid or Allkids (the Children’s Health Insurance Program in Alabama). Visit HealthCare.gov to find an insurance plan in Alabama that is appropriate for your family, and to check your eligibility for Medicaid or Allkids.

We will continue this topic in a subsequent blog. Stay tuned!