“Eye Care” For You

What Does My Insurance Cover For My Eye Exam?

Dr. Parker-Herriott
Dr. Parker-Herriott

With the addition of new managed care insurance plans and the changes in insurance benefits this year, it is certainly a legitimate question to ask. And…, the end of the year is the time to really know if you have maximized your insurance benefits for the year. My staff asked me to write about this topic as they are asked this question several times a day. They feel it would help patients know what to expect if you are using insurance for your appointment.

Most government insurances such as Medicare or Medicaid cover an eye exam. Medicare will cover an exam more than once if needed for medical reasons. There is a small portion of the examination that is not covered by Medicare and the patient is responsible. Medicare also covers 80% of the costs allowed for services. If you have a secondary insurance, your provider will file it to pay the remaining 20% of the services. It is the patient’s responsibility to inform the doctor’s office if there is a secondary insurance, so be sure to ALWAYS take your insurance cards and proper I.D. when you have doctor visits. Medicaid coverage is different from Medicare. The annual examination is only covered once per year but you may be eligible for visits related to problem with your eyes. A co-pay may be required. Some Medicaid plans also have age requirements. Therefore, check your plan benefits before you schedule your appointment to be sure you are eligible for vision benefits. Private insurances such as Blue-Cross /Blue Shield, Aetna, Cigna, and others have specific benefits for and sometimes allow vision or medical benefits for eye care one time per year. Many private insurance companies have ‘vision plans’ (such as VSP, Vision Care Plan, Spectera {formerly Optum Health}, Eye Med, or others affiliated with them). Always read your insurance benefits or contact your insurance carrier before your appointment. My staff is qualified and trained to read and explain insurance benefits if such help is needed. As much as I enjoy writing about health issues, I hope this article will be helpful when you schedule your next eye exam. Remember to use your benefits before the end of the year. I f you do not have an eye care provider, I invite you to visit EnVision Eye Care for your next eye examination. We accept Medicare, Medicaid, Tricare, and most private insurances. We also have promotions for those who do not have vision insurance or benefits. Be sure to ask about our “See Clearly Vision Plan”. 321 W. Montgomery Crossroads, Savannah (near Hunter Golf Course and VA Medical Clinic). For appointments, call (912) 927- 0707 and visit www.envisionsavannah.com


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