Vision Savings Plan versus Medical Insurance for Eye Care: Understanding the Difference

By Troy Ogden, DO

Not surprisingly, many of our patients are confused about their medical and vision benefits. Not only are health plans complicated and hard to understand, but customer service representatives and brokers have been known to provide incomplete or bad information about benefits.

The two most used vision plans are Eyemed and VSP. Eyemed is accepted at both commercial and private optometry and offices. VSP is accepted only at private offices, such as Downtown Vision.

Vision benefits covers routine eye exams, where the optometrist isn’t monitoring serious conditions such as diabetes or macular degeneration, and does not cover medical eye problems, like conjunctivitis (aka pink eye), diabetes or macular degeneration.

Medical insurance, depending on your benefits, will cover all eye conditions/diseases, and sometimes will cover routine vision. We always ask for both medical and vision benefits coverage to make sure you are getting the best possible care while utilizing your benefits to the fullest.

Many patients come into the office with conjunctivitis and think that because they don’t have vision coverage that they don’t have any insurance at all. Conjunctivitis is a medical problem and is covered by your medical insurance. Unfortunately, sometimes you will need prior authorization from a primary care provider to be seen for these eye conditions.

Some medical insurance plans include “routine vision” coverage, especially for pediatric exams, which allows you to get a comprehensive eye exam for $0 out -of-pocket, or as much as your regular insurance co-pay. This is a little known and often over looked benefit, especially for people with no vision specific coverage. Every plan is different, and while we do our best to understand the various plans and help you out when we can, it is best to contact your provider to find out what benefits are available on your plan.