What Insurance Covers Ophthalmologist?

What Insurance Covers Ophthalmologist? 65941493a5943.jpeg

With 2024 nearly upon us, many people are finalizing their insurance plans for the upcoming year. As the old year wraps up, you may be reviewing your current medical insurance and making any necessary changes.

Generally speaking, health insurance in the United States can get a bit complicated. Some people get their insurance through their employer, while others get theirs through the government marketplace. Some people qualify for programs like Medicaid or Medicare, while many more people don’t have any insurance at all.

While it’s well-known that most medical insurance plans don’t cover dental insurance, what about vision insurance? After all, your eyes are a very important part of your overall health.You want to get routine eye exams, and if you do need contacts or glasses, seeing an eye doctor is even more important.

Learn more about which insurance options cover an ophthalmologist in this guide from Milwaukee Eye Surgeons.


Is Vision Insurance Part Of Medical Insurance?

The answer to his question is mostly no, but it’s complicated. Vision insurance and medical insurance are two separate things, but there can be some overlap in what they cover.

Medical insurance covers issues related to medical care or issues that you’d need to see a doctor for. Some eye care professionals are doctors, while others are not. Eyecare professionals who are medical doctors are known as ophthalmologists, while eye care providers who don’t finish medical school are optometrists.

Some treatments provided by ophthalmologists are covered by medical insurance, while other treatments are only covered by vision insurance. Basically, it comes down to classification and billing.

Medical insurance is one kind of coverage and is usually meant for things related to your ophthalmologist, while vision insurance covers visits to the optometrist and some ophthalmology services.


Eye Care Services Covered By Medical Insurance

When you have medical issues with your vision, you need to see a medical doctor, also known as an ophthalmologist. These eye doctors can treat eye diseases and prescribe medication.

When you need an eye doctor to treat an eye disease or perform eye surgery, the treatment is usually covered by medical insurance.

Eyecare Services Covered By Vision Insurance

Vision insurance covers most routine eye exams and vision services that aren’t specific to ophthalmologists. Keep in mind that both ophthalmologists and optometrists can do things like prescribe contact lenses and glasses and provide an annual eye exam.

Most services related to eye exams, correct lenses, glasses, and frames are billed under vision insurance.

Are Eye Exams Covered Under My Health Insurance?



Seeing an optometrist or ophthalmologist for an annual eye exam is important for everyone, especially for those who have vision issues or higher risk factors for eye problems. But, you may wonder if this important preventive visit is covered by your regular medical insurance.

The Affordable Care Act (ACA), sometimes known as Obamacare, requires all medical insurance plans to cover eye diseases such as glaucoma, cataracts, macular degeneration, and diabetic retinopathy. So, if you have any of these conditions, you will likely have an eye exam covered through your medical insurance, as these are classified by insurance as medical problems.

The ACA also requires health plans to cover vision care for patients under 19 years old. So, children can have most preventive eye care covered under medical insurance, cinlduing annual eye exams and prescriptions for contact lenses or glasses.

What Medical Insurance Usually Doesn’t Cover

While the ACA requires regular medical insurance plans to cover some issues related to the eyes, most qualified health plans under this initiative don’t cover vision for adults. Because of this, it’s possible that your medical insurance won’t cover vision issues, such as mild eye diseases, routine eye exams, and treatment for refractive errors.

Many medical insurance plans also don’t provide coverage for contact lenses or eyeglasses.

How To Know Exactly What Vision Coverage You Have

Keep in mind that the information in this guide is broad. There are many intricacies in the healthcare insurance system, and what is covered under an insurance plan varies greatly depending on your insurance provider and your exact plan.

If you have a better plan, you’ll likely get more coverage. It’s also important to remember that not all plans have the same deductibles or benefits. The only way to know for sure what your insurance covers is to reach out to them directly. They can tell you what is covered and what the out-of-pocket costs will be for you.

Should I Purchase Separate Vision Insurance?


Because a lot of eye care services aren’t covered under regular medical insurance, you may wonder if it’s worth it to purchase separate vision insurance.

While having vision coverage is generally beneficial, some people need these services more than others.

The best way to know how often you need to see an eye doctor is to get professional medical advice through a consultation. But, here are some signs you may need to get a separate vision insurance plan:

  • You have vision problems: If you have eyeglasses or contact lenses, you’ll likely save money by getting vision insurance. This way, you’ll get more services covered, including an annual vision exam.
  • You have a family history of vision issues or eye disease: If you know that certain eye disease issues run in your family, going to the ophthalmologist often is important. As they are a medical doctor, they can catch warning signs early on.

Overall, you’ll want to weigh the cost of the vision insurance plan versus how often you’ll likely need to see an eye care professional.


Milwaukee Eye Surgeons Accepts Most Insurance Plans

At Milwaukee Eye Surgeons, Dr. Weinlander is a board-certified ophthalmologist. As such, many of the services in our office are covered by health insurance plans. We accept any insurance plans, including Blue Cross, Aetna, Cigna, and Medicaid.

Call today to learn more about our insurance options or to set up an appointment. 

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