MEDICAL: Aetna, Blue Cross Blue Shield (BCBS), United Health Care, Medicare, Some Cigna Medical Plans AND OTHERS

VISION: Aetna, Avesis, Always Care, AARP, BCBS, Cigna Vision, Davis Vision, Eye Med, Humana, Medicaid (Amerigroup, Block, Opticare, Traditional), NVA, Superior Vision AND OTHERS.

The specifics of medical insurance can be confusing, and vision coverage is no exception. Insurance companies usually categorize visits to your eye doctor as either "routine" or "medical”. This has little to do with the steps it takes to perform a full eye exam. A "routine" vision exam often contains the same elements as a "medical" eye exam.

Also, the type of eye doctor you see does not determine if the examination is termed routine or medical, and either an optometrist or an ophthalmologist can perform the exam.

The reason for being seen and the results of the examination often determine whether insurance will classify the exam as routine or medical. The difference is determined by the reason for the visit, such as symptoms and complaints, and also the patient’s diagnosis. Insurance companies often look at both when determining payment. The routine vision exam usually produces a final diagnosis, such as “nearsightedness” or “astigmatism”, while the medical eye exam produces a diagnosis such as "conjunctivitis" or "cataract."

Routine vs. Medical Eye Exams

Depending on your policy, your medical insurance may cover a medical eye problem, but not pay for the exam if it is a "routine" eye exam. Other policies contain vision plans that provide coverage for glasses and contact lenses or at least give you some type of discount on the doctor’s usual and customary fees. Many times, people with medical insurance have a separate rider policy to cover routine eye exams. To complicate matters more, some medical insurance will cover one routine eye exam every two years in addition to covering eye exams that are for a medical eye problem. And the co-pay for each type of exam may be different!