When it comes to eyes and vision, there is often confusion as to what services are covered. Most companies provide medical insurance; the traditional health insurance guarding against catastrophic medical bills, doctor’s bills, etc. Many more companies will provide a prescription plan and vision insurance.
Vision vs. Medical Insurance – Vision insurance typically will “pay for” glasses or contacts and an “eye exam.” In a nutshell, vision insurance pays for the services and goods required to obtain proper glasses or contact lenses. It probably does not cover a dilated eye exam. Check with your eye doctor or your insurance plan to verify. Vision insurance does not usually pay for any “health related” vision problems such as diabetic retinopathy, macular degeneration, cataracts, glaucoma, etc.
Medical insurance pays for the health services necessary to diagnose and treat health related eye problems. Patients with medical eye diseases are covered by medical insurance.
Get a Dilated Eye Exam – If you have either macular degeneration or diabetic retinopathy, the only way a complete, and thorough, eye exam can be performed is by having a dilated eye exam. It is imperative that your eye doctor get the chance to look at your retina with the pupil fully dilated to allow an unimpeded view of your retina. While there are special cameras allowing a picture of the retina “without dilation,” this does not substitute as a thorough eye exam.
What Does This Mean? Simply put, if you have medical insurance, and have a medical eye problem, you should be able to have a complete, dilated eye exam that is covered by your insurance. Your eye doctor should be able to fully examine and treat you for any medical eye problem. Patients with diabetic retinopathy and macular degeneration require routine, dilated eye exams. These are health issues, not “vision.”
If you have vision insurance only, and not medical insurance, you may need a complete dilated eye exam, but check with your doctor to make sure what is covered by insurance.