Does Insurance Cover Eye Exams? VSP, EyeMed, Medicare and More

Eye care insurance confuses almost everyone, because two different kinds of coverage can apply to the same visit. Here's the plain version.

Vision plans vs. medical plans

A vision plan (VSP, EyeMed, Davis Vision, Spectera, Superior Vision) covers routine care: the annual comprehensive exam, refraction, and a contact lens fitting allowance. A medical plan, including Medicare, covers eye problems and disease: dry eye, glaucoma monitoring, diabetic eye exams, infections, sudden vision changes, and injuries.

How both can apply to one visit

If you come in for a routine exam and we find or monitor a medical condition, part of the visit may bill to your medical plan and part to your vision plan. That isn't double billing; they cover different services.

What Medicare covers

Medicare does not cover routine vision exams for glasses, but it does cover medically necessary eye care, including annual diabetic eye exams and glaucoma screening for higher-risk patients.

Typical out-of-pocket items

Copays, refraction fees on some medical plans, contact lens fitting fees beyond the plan allowance, and any care exceeding your annual allowance.

The takeaway

We accept Davis Vision, EyeMed, Medicare, Spectera, Superior Vision, and VSP, and we verify your benefits before your appointment so there are no surprises. Call us at (805) 562-1300 with your plan details and we'll check for you.