Many people do not fully understand what their insurance covers when it comes to vision care. It is important to have a clear understanding of the procedures that are covered and those that are not.

This guide aims to provide you with an overview of the different types of eye procedures covered by insurance and those that are not.

Eye Exams

Most insurance plans cover annual eye exams as a preventative measure to detect any vision problems early on. Eye exams can also detect medical conditions such as high blood pressure and diabetes.

However, it is important to check with your insurance provider to make sure that your specific plan covers this.

Prescription Glasses

Prescription glasses are usually not covered by insurance, but some policies may offer a partial reimbursement. It is important to read the details of your insurance policy to determine what you are covered for.

If your insurance does not cover the cost of prescription glasses, you may be able to use a flexible spending account or health savings account to offset the cost.

Contact Lenses

Some insurance plans will cover the cost of contact lenses, but usually only for a certain amount per year.

Others may only cover contact lens purchase or replacement if it is medically necessary due to a particular condition or to correct vision that cannot be corrected with traditional glasses. Some insurance plans may cover the cost of contact lens fitting and follow-up appointments as well. Check with your insurance provider to see if your policy includes contact lens coverage.

Laser Eye Surgery

Laser eye surgery, also known as LASIK or PRK, is a surgical procedure used to correct vision problems such as nearsightedness, farsightedness, and astigmatism. This type of procedure is typically not covered by insurance as it is considered elective.

However, some insurance providers may offer a discount on the cost of the procedure if it is performed by a provider within their network. If this procedure is not covered by your insurance, you may be able to use financing options or a health savings account to pay for it.

Cataract Surgery

Cataract surgery is a common procedure used to remove clouded lenses from the eyes. It is considered medically necessary and is usually covered by insurance. However, the exact coverage may vary depending on the type of insurance plan you have.

It is important to review the details of your policy to determine what is covered and any out-of-pocket costs you may need to pay.

Retinal Detachment Surgery

Retinal detachment occurs when the retina, the thin layer of tissue at the back of the eye responsible for vision, becomes separated from the underlying support tissue. It requires urgent and often surgical treatment to prevent permanent vision loss.

Retinal detachment surgery is usually covered by insurance, but check with your provider to determine the exact coverage you have.

Glaucoma Surgery

Glaucoma is a condition that can damage the optic nerve, resulting in vision loss. Eye drops can be used to manage the condition in the early stages, but surgery may be required as the condition progresses.

Most insurance plans cover the cost of glaucoma surgery, but as always, it is important to check with your provider to determine what coverage you have.

Corneal Transplant Surgery

A cornea transplant involves replacing a damaged or diseased cornea with a donor cornea to help restore vision.

The surgery is usually covered by insurance, but how much you will have to pay out-of-pocket will depend on your insurance provider and specific policy details.

Conclusion

It is important to understand what eye procedures are covered by your insurance and what your potential out-of-pocket costs may be.

By reviewing your policy details and talking with your insurance provider, you can help ensure you get the coverage you need for the eye procedures you require.