Medical Insurance Pays for Your Eyes. Vision Insurance Pays for Glasses. The Difference?

Medical Insurance Pays for Your Eyes. Vision Insurance Pays for Glasses. The Difference?

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.


Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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  • Dodge
    Posted at 12:44h, 30 November Reply

    I deal with this issue every day. The short cut way I think of it is “Vision insurance covers one healthy person eye exam a year. Everything else is done with medical insurance.” Kinda my simple rule of thumb, where things get really interesting is when people think they are healthy and really are not.
    hope that helps a little

    • Randall V. Wong, M.D.
      Posted at 20:46h, 30 November Reply

      Thanks for your insights. This is really an ongoing problem for the primary providers isn’t it?


  • teresa weber
    Posted at 15:24h, 30 November Reply

    Love this, Randy. So simple, yet so fully explained…. Thanks!

    • Randall V. Wong, M.D.
      Posted at 20:47h, 30 November Reply

      This is problem that won’t go away. It is something that is very difficult for most patients to understand.


  • Dick
    Posted at 19:37h, 30 November Reply

    this is a good clarification of a usual misconception that patients are having

    • Randall V. Wong, M.D.
      Posted at 20:48h, 30 November Reply


      As you can see, not only is it sometimes difficult to get a patient to understand that he has disease, but it is very difficult for some to understand that their “insurance” doesn’t cover health problems.

      Thanks for commenting.


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