Eye Care For You

What Does My Insurance Cover For My Eye Exam?

J.A. Parker
J.A. Parker

With the addition of new managed care insurance plans and the changes in insurance benefits each year, this is certainly a legitimate question to ask. And, BEFORE the end of the year is the time to know if you have maximized your insurance benefits.

Most government insurances such as Medicare or Medicaid cover an eye exam every year. Medicare will cover an exam more than once a year if needed for medical reasons. There is a small portion of the examination that is not covered by Medicare. For this part, the patient is responsible. However, Medicare will cover 80% of all the other allowed services. If there is a secondary insurance, the office may file it to pay the remaining 20% of the services that are not covered by Medicare. It is the patient’s responsibility to inform the doctor’s office if there is a secondary insurance. 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 also be required. Some Medicaid plans also have age requirements to receive glasses benefits. Therefore, check your plan before you schedule your appointment to be sure you are eligible for vision or medical benefits.

Private insurances such as Blue-Cross /Blue Shield, Aetna, Cigna, United Healthcare, and others have specific benefits that may allow either vision or medical benefits for eye care one time per year. Many private insurance companies are connected to ‘vision plans’ (such as VSP, Vision Care Plan, Spectera, Eye Med, or others affiliates). Sometimes the office may have a difficult time determining this, but you may check with your human resource department and they can certainly inform you of this information.

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 you need additional help. Knowing this information ahead of time can save lots of time and keeps your appointment from being delayed when you arrive.

As much as I enjoy writing eye health articles, I hope this article will be helpful for you when you schedule your next eye exam. REMEMBER TO USE YOUR BENEFITS BEFORE THE END OF THE YEAR. USE IT…, or LOSE IT!!!

If you are in need of an eye care provider, I invite you to visit EnVision Eye Care for your next eye examination. We accept Medicare, Medicaid, Tricare, and many private and vision insurances. We also have promotions for those who do not have vision insurance or benefits. Ask about our “SEE CLEARLY YEARLY VISION PLAN.”

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