At Fidler Eye Care, one of the most common — and confusing — questions we hear is:
“Is this exam covered by my vision insurance or my medical insurance?”
It’s a fair question. The line between medical and vision insurance isn’t always clear — especially when it comes to your eyes. But understanding the difference can help you avoid unexpected charges, maximize your benefits, and streamline your visit.
Let’s break it down.
Vision Insurance Covers Routine Eye Exams
Vision insurance is designed to support your visual needs and preventive eye care. It typically includes:
- Annual routine eye exams
- Eyeglass or contact lens prescriptions
- Allowances or discounts on frames and lenses
- Screenings for visual acuity or glaucoma
Plans like VSP, EyeMed, or Davis Vision cover services related to how well you see — not necessarily your eye health.
Example: You visit for your annual exam and want to update your glasses. No medical complaints. That’s a vision insurance visit.
Medical Insurance Covers Eye Health Issues
Medical insurance (e.g., Aetna, Blue Cross, Medicare) applies when your visit involves a health concern. These include:
- Eye infections, injuries, or redness
- Dry eyes or sudden blurry vision
- Diabetes-related eye exams
- Diagnoses like cataracts, glaucoma, or macular degeneration
Even if you receive a glasses prescription during your visit, medical insurance is billed if the appointment is prompted by a health issue.
Example: You come in for red, itchy eyes. Even if you also get a glasses check, your visit is medical because of the underlying issue.
Why It Matters — Especially at Check-In
Here’s why understanding the difference is important:
- We are required to bill based on the reason for your visit — not your preference.
- Vision and medical plans are completely separate — and don’t share information.
- You may have a co-pay or need to meet your medical deductible for non-routine visits.
How to Make Your Visit Smoother
We want your experience to be seamless. To help us direct your visit appropriately:
- Bring both your medical and vision insurance cards
- Let us know why you’re coming in (routine vs. medical concern)
- Upload your insurance and forms in advance, if possible
This allows us to route your benefits correctly — and avoid billing surprises.
New Insurance Policy Disclosure
To improve transparency, we’ve added a clear notice to our website:
“Routine eye exams are billed to your vision plan. Medical visits (for conditions like infections, diabetes, or eye disease) are billed to your health insurance. Some services, such as retinal imaging, may incur an additional fee.”
We want you to know what to expect before your visit — and feel confident about your care.
Still Have Questions?
No worries — our team is here to help. We can verify your eligibility and benefits and walk you through which plan applies.
Call us at 954-467-3777 or visit us in today.