Does Medical Insurance Cover Vision?
Posted: August 21, 2024
Your vision is essential to your overall well-being and can give clues about your physical health. For example, during an eye exam, the doctor might spot signs of conditions like diabetes or high cholesterol.
Considering your vision is vital, you think it’d be covered by your health insurance plan, right? In some cases, it is. However, most standard health insurance policies do not cover routine eye exams.
How Do You Know If You Have Eye Insurance?
Every health plan is different. The best way to know if you have vision coverage is to review your health policy’s Summary of Benefits and Coverage (SBC). You should be able to find your plan’s SBC by visiting its website. If you have any questions about your Covered California plan or where to find your SBC, our representatives can help.
Your medical insurance may provide eye care coverage if any of the following apply:
- You have full-scope Medi-Cal.
- You need treatment for an eye disease, infection or injury.
Ophthalmology vs. Optometry
It’s important to note that health insurance plans typically cover ophthalmology services. Ophthalmology deals with diagnosing and treating eye disorders — and it’s different from optometry. An ophthalmologist is a medical doctor who can perform eye surgery and treat conditions like cataracts and glaucoma.
Optometry, by contrast, focuses on basic vision care, such as performing vision tests and prescribing contact lenses. An optometrist is not a medical doctor but has a Doctor of Optometry degree. Most plans do not cover optometry services.
Why Is Vision Not Covered by Insurance?
Most health insurance plans do not cover basic vision services because they’re not considered essential by the Affordable Care Act (ACA).
Under the ACA, Covered California health plans must provide 10 essential benefits, such as emergency care and prescription medications. Although health insurance companies may choose to offer vision benefits, they aren’t required to under the ACA.
However, ACA does require vision coverage for children. This means a child’s eye exam and glasses are covered by their medical insurance.
How Can You Get Vision Insurance?
You can get vision insurance to supplement your current health plan or as a stand-alone policy. You do not need health insurance to get vision coverage. You can also enroll in a vision plan year-round.
Covered California has partnered with VSP and EyeMed to make it easy and affordable for Californians to get vision coverage. You will not enroll in these plans through Covered California, but the process is still simple. You can begin by getting a quote on the VSP or EyeMed site.
Do You Have More Questions?
At Health for California, we understand health insurance can be tricky to navigate. If you have any concerns or questions about your Covered California plan or need us to point you in the right direction, we’re happy to help you the best we can. Contact us today to speak with a knowledgeable agent.