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Eye Exams & Insurance: Coverage

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Keeping vision and eyes healthy is an important part of overall health for both children and adults.

However, insurance coverage for eye exams can be a confusing topic. How often you should see an eye doctor for various medical eye conditions and insurances is at the discretion of your doctor following standard guidelines. The information below is a brief and general overview of how medical and vision plans generally work.

One important note: it is the patient’s responsibility to understand how their plan works and what is covered. If you have questions about your plan, call the number on your insurance card. By understanding how your plan(s) work, your office visits will be more pleasant and productive.

A Few Examples of What Insurance Covers

Medical Plan

  • Sudden loss of vision
  • Eye pain
  • Lazy eye
  • Double vision
  • Pink eye
  • Spots/floaters
  • Eye injury and/or foreign body
  • Eye allergies
  • Dry eyes
  • Styes
  • Ocular migraines
  • Headaches
  • Diabetic eye exams
  • Contact lens complications including ulcers
  • Glaucoma and cataract diagnosis, co-management, and referrals

Vision Plan

  • Myopia (nearsighted)
  • Hyperopia (farsighted)
  • Presbyopia (difficulty focusing)
  • Astigmatism
  • Computer eye strain
  • Lenses
  • Frames
  • Contact lenses

Have questions about insurance and eye exams? Check out answers to frequently asked questions.

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