Vision and medical insurance cover different parts of eye care. Here is what to know before your visit.
Vision insurance
Vision insurance covers routine, preventive eye care — your annual eye exam, and an allowance toward glasses or contact lenses. Think of it as a wellness benefit. It is usually a separate plan from your health insurance, often bought through your employer, with its own card.
Medical insurance
Medical insurance covers eye care that treats a medical problem — dry eye, infections, injuries, glaucoma, cataracts, diabetic eye exams, sudden changes in vision. If your visit involves diagnosing or managing a condition, it is billed to your medical plan, not your vision plan.
Many patients have both, and one visit can involve both. If you come in for a routine exam and we find something that needs medical attention, part of your visit may be billed to your medical insurance. That is normal, and we will always explain it before you leave.
Carrier names are listed alphabetically. Participation and benefits vary by plan.
Plan participation can change, and coverage varies by the specific plan within each carrier — two people with the same insurer can have very different benefits. Please call us at (610) 642-2151 to confirm your plan and what it covers before your visit. We are happy to check for you.
No. We see patients with vision insurance, with medical insurance, and with neither. Ask us about self-pay pricing when you book.
If your visit involved diagnosing or managing a medical condition — dry eye, an infection, diabetes-related screening, glaucoma monitoring — it is billed to medical insurance. Routine vision checks go to your vision plan.
Often yes. We will tell you before you leave which parts of the visit went where.
Usually it provides an allowance toward frames and lenses rather than covering them completely. We will show you exactly what your plan covers before you choose.
Coverage for myopia-control lenses such as Stellest is improving and some vision plans now contribute toward them. We also work with CareCredit so families can pay over time. Call us and we will check your specific plan.
Call us anyway. We can often still see you, explain your out-of-network benefits, or give you self-pay pricing up front so there are no surprises.
Call before your visit and we will help confirm your plan and explain what it covers.
