Your eyes are your windows to the world, and it’s important to take care of them by getting routine checkups. Yet in the complicated world of American healthcare, vision services aren’t normally included in medical insurance. You need a separate additional plan, and even then, figuring out what your vision insurance does and doesn’t cover can be complicated. 

To help clear things up, we spoke with some experts to break down key differences between medical insurance and vision insurance. 

What is the difference between medical and vision insurance?

Medical insurance is your general health plan. An employer might supply it, or you might purchase a plan yourself on the marketplace.

Vision insurance is supplemental; it’s elective coverage you add on top of your medical insurance. 

Vision insurance is intended to cover more routine eye care: yearly expenses, like annual exams, contact lens fittings and new frames and lenses for glasses. For common eye issues like nearsightedness, farsightedness or astigmatism, vision insurance can help cover the yearly costs of care. It may also offer discounts on LASIK procedures, specialty contacts or other specialty eye care. Most à la carte vision insurance plans range from $5 to $20 a month. 

More complex eye issues are often covered by medical insurance. Problems like cataracts, corneal disorders and glaucoma are generally considered medical care, so the eye doctor’s office will likely bill related services to your medical insurance. 

“People think, ‘I can’t go to the eye doctor because I don’t have vision insurance,’ but lots of times, it’s an issue that could be medical,” said Heidi Campbell, director of clinical operations at Duke University’s Duke Eye Center in Durham, North Carolina. “So if you’re having blurry vision or floaters, that’s something your medical insurance will likely pick up.” 

Many medical insurance plans offer yearly routine eye exams, which may be enough for families without any eye issues. Medical insurance also offers more comprehensive vision care for children; under the Affordable Care Act, all qualified health plans must cover basic eye care for dependent children under 19, including annual exams, glasses and/or contact lenses. 

Do optometrists and ophthalmologists accept both medical and vision insurance?

Many optometrists and ophthalmologists accept both types of insurance, but much depends on the specific office and what kind of eye care you’ll need. Some ophthalmology offices may accept vision insurance for routine eye care, but they generally treat more complex eye issues and perform eye surgery, procedures which are more likely covered by medical insurance. 

Optometrists are like the primary health providers for eyes. They conduct routine eye exams to scan for any vision defects or signs of illness and fit patients for contact lenses and glasses. For this reason, optometrists’ offices generally accept vision insurance. However, accepted plans vary from office to office, so be sure to check with the office about your coverage ahead of time. 

How do I know whether I have medical insurance or vision insurance?

Check with your employer or your insurance plan to see which kinds of coverage you have. Some plans add on vision insurance automatically, or you may have opted into vision insurance without realizing it. Once you know whether you have medical insurance, vision insurance or both, check your policy or contact your insurance provider to see what’s covered.

Does everyone need vision insurance?

Paying for supplemental vision insurance will depend on what’s covered in your medical plan, as well as the specific eye care needs of your family. For families with no vision issues, a medical plan that covers annual eye exams may be enough.

If you’re interested in supplemental vision insurance, talk to your insurance provider about the plan that’s right for you.