Vision Coverage vs. Medical Insurance

We often have patients who have both vision plans (for example, VSP or EyeMed) and medical insurance (for example, Blue Cross, Aetna, United Health Care, or Medicare). They are very different in terms of the services they cover, and it’s important for our patients to understand these differences.

Vision plans are designed mainly to cover tests for determining a prescription for glasses, to help pay for glasses or contact lenses, and to cover a yearly routine evaluation of the health of the eyes in a healthy patient that has no particular problems or symptoms. It is not equipped to deal with and does not usually cover medical conditions, injuries, and/or treatments.

Medical insurance is designed to cover you when you have a medical problem, including one that affects your eyes. Medical insurance does not cover routine services or examinations for glasses, or routine vision problems such as nearsightedness, farsightedness, and astigmatism.

When there is a medical diagnosis or a medical condition that affects your eyes, we must file the claim with your medical insurance, and the co-pays and deductibles for that insurance will apply. Your vision plan does not cover these kinds of problems. Please understand that these rules are made by the insurance companies, not our office, and we must comply with them.

There is often no way to know prior to your examination which type of insurance will cover your visit. If we are on your insurance company’s panel we will file those claims for you. In the event that we do not accept your medical insurance or vision plan we will provide you with an itemized receipt so that you may file a claim for reimbursement with your insurance company yourself. If you have any questions, please let us know.

Plans We Accept

We accept most medical insurance, including Blue Cross, United Health, Medicare, Medicaid, Neighborhood Health Plan, Tufts Health Plan, and VSP. Call us with any questions you have about your insurance—we’ll get the answers!