What is the difference between Vision Insurance and Medical Insurance?

There is significant confusion regarding these two types of insurance coverage. Many people have both types of these insurance’s.

Vision insurance plans cover ROUTINE eye care only. Examples of this are nearsighted, farsighted, and regular astigmatism. These Vision insurance examinations are wellness exams meant for more routine examinations. The Vision insurance often covers a portion of glasses or contact lenses and contact lens services. If the doctor diagnoses a medical related eye problem during this routine examination, you will need to return for further testing and evaluation to assist the diagnosis and management of the medical issue.

Medical health plans do not usually cover routine examinations for nearsighted, farsighted, and astigmatism. Most medical health insurance’s do not cover glasses, contact lenses or contact lens evaluations and fittings. Medical insurance is to be used when the patient needs to have a medical eye related evaluation. Medical eye insurance related examples are eye infections, glaucoma, glaucoma suspect, cataracts, macular problems, diabetic eye issues, flashes of light or floaters evaluation or other disease related eye problems.

It is not always possible to know before seeing a patient which insurance plan will be used. That is depending on the diagnosis of the patients problems. It is common the vision exam is used first, then the patient returns for further medical eye evaluations on a later visit.

Both types of insurance have co-pays and or co-insurance that vary with the insurance plan. If both types of insurance are needed, another evaluation visit is scheduled. Each visit will have its respective insurance co-pay on each date of service.

 Insurance plans Academy Eye Associates, OD participates with : 

(Each office and provider varies with the insurance plans they participate with )

  • Aetna
  • Blue Cross Blue Shield
  • Community Eye Care
  • Eye Med
  • Humana
  • Medicare
  • Superior Vision
  • United Health Care
  • Vision Service Plan (VSP)
  • Wellpath

Important: Please check your individual plans benefits for more specifics about your benefits and co-pays

Durham Office - Academy Road
  • 3115 Academy Road
  • Durham, NC 27707
  • 919-493-7456
  • Dr. Powell & Dr. Greene
Chapel Hill Office - MLK Jr. Blvd.
  • 910 Martin Luther King, Jr. Blvd.
  • Chapel Hill, NC 27514
  • 919-942-8531
  • Dr. Canterbury & Dr. Wujciak