Vision Plans vs Medical Insurance Explained

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Vision plans are different from medical health insurance. Vision plans provide wellness and vision benefits only. Most vision plans cover an annual eye exam with discounts on eyewear and contact lenses. Examples of vision plans include VSP, EyeMed, Davis Vision, and Superior Vision.

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What are the Benefits of Vision Plans?

• Low copay or no copay annual vision and eye wellness exams

• Discounts on eyeglass frames

• Discounts on eyeglass lenses

• Discounts on contact lenses (if eligible)

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Vision Plan benefits vary by plan.

Always verify your specific coverage before your appointment

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What Vision Plans Do NOT Cover

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Vision plans exclude "medical" eye exams including treatment and management of medical eye conditions. Examples of common medical eye conditions include:

• Vision loss

• Floaters

• Dry eyes

• Allergies

• Infections

• Eye diseases

• Diabetes-related complications

• Glaucoma

• Cataracts

• Red eye

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When do I use my medical insurance at the eye doctor’s office?

 

Medical insurance is required if you have an eye problem or eye disease that requires treatment and management, or if a medical condition is present that causes eye problems. Some common conditions for which we can bill your medical insurance include:

• Dry eyes

• Itchy eyes or eye allergies

• Floaters

• Red eye or infections

• Vision loss

• High risk of glaucoma / ocular hypertension / glaucoma diagnosis

• Monitoring cataracts

• Diabetes examinations

• Medication side effect monitoring

• Macular degeneration

• Systemic conditions with eye complications

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What is refraction?

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• A refraction is a procedure to check for changes in an existing eyeglass prescription or determine the need for eyeglasses. The cost for a refraction is $45 and this fee is typically not covered by medical insurance.

• Vision plans will cover refraction, but not the exam when it is related to a medical complaint.

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Can I use my vision insurance and my medical insurance for a joint exam on the same day?

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No. Typically, medical insurance and vision plans require separate examinations. Bundling a vision plan exam and medical exam together may result in neither insurance covering your doctor’s services. If you need both medical eye care and vision services, it is best to schedule each on a separate day to ensure proper insurance billing.

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Important reminders!

 

• Before scheduling, check with your vision plan and medical insurance to verify you can be seen at the IEI.

• When scheduling, explain your visit's purpose (vision vs medical) to ensure proper insurance billing

• Always bring both vision plan and medical insurance cards

• Medicare does not cover routine non-medical eye exams for glasses/contacts. You will be responsible for all non-medical exams and refractions costs.

• Some Medicare Advantage plans offer a separate vision plan for annual non-medical vision eye exams. For example, if you want a refraction for glasses with a routine eye exam, present the vision plan information when you schedule the appointment. If during your routine exam, a medical eye condition is detected, you will need to return on a separate day for a medical eye appointment which will allow your doctor to evaluate and manage the condition. This medical eye exam will be billed to your medical insurance.

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The Illinois Eye Institute participates in a variety of health insurance products and plans including Medicare and Medicaid. If the Illinois Eye Institute is listed in your insurance company's network, you’ll be able to receive care at our facilities with your “in-network” benefits. That means your insurance company has agreed to accept certain negotiated rates, which can lower your out-of-pockets costs.

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If your insurance network does not include the Illinois Eye Institute, but has out-of-network benefits, you may have a higher out-of-pocket responsibility than if you received services from an in-network provider.

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Our list of accepted insurance providers is subject to change at any time.

 

You should contact your insurance company to confirm the Illinois Eye Institute providers participate in their network before scheduling your appointment. Your insurance company's customer service representative can also help you verify your benefits, out-of-pocket costs and coverage.

 

If you don’t have vision plan and are interested in learning about your options, VSP offers several options for affordable vision plans, click here to find out more : VSP individual vision plan. 

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If you do not have insurance or do not see your provider on this list, you may still qualify for discounted care based on IEI Vision of Hope program. Click here for more details and for the application form.

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Questions? Concerns? Please call 312-225-6200.

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