Insurance for eye care is confusing for many patients. You may ask: “Does my vision plan cover cataracts?” or “Why was my eye exam billed through health insurance?” At Pikes Peak Eye Care in Colorado Springs, we aim to demystify the differences between medical eye insurance and vision insurance plans, so you understand what’s covered — and when.
What Does Medical Eye Insurance Cover?
Medical eye insurance is part of your health insurance. It applies when your eyes require treatment beyond routine vision care — in other words, when there is a medical condition or disease. Examples include:
- Eye infections or injuries
- Glaucoma
- Cataracts
- Diabetic eye disease or diabetic retinopathy
- Macular degeneration
- Flashes, floaters, sudden vision changes
- Chronic dry eye (if diagnosed as a medical condition)
If your visit involves diagnosing or treating an eye disease, we bill your medical insurance rather than your vision plan.
Example: You have diabetes and need a retinal exam. That is billed through your medical insurance, not VSP or EyeMed.
What Do Vision Insurance Plans Cover?
Vision insurance plans (e.g. VSP, EyeMed) exist to help with routine vision maintenance. Coverage typically includes:
- Annual comprehensive eye exams
- Eyeglass lenses and frames (within set allowances)
- Contact lenses
- Lens upgrades (anti‑glare, blue light filtering, transitions)
- Discounts on frame or lens add‑ons
Vision plans do not cover medical treatment for diseases or conditions — so vision benefits won’t apply to cataracts or glaucoma treatment.
Common question: “Does vision insurance cover cataracts?”
No. Cataract treatment is considered a medical procedure and goes through your medical insurance.
Medical vs Vision Insurance — Side‑by‑Side Comparison
| Medical Eye Insurance | Vision Insurance Plans |
|---|---|
| Covers treatment of diseases, injuries, eye emergencies | Covers routine eye exams, glasses, contact lenses |
| Billed under health insurance policies | Billed via VSP, EyeMed, or another vision plan |
| Often involves deductibles, referrals, and co‑payments | Usually fixed copays and annual allowances |
| Includes conditions like glaucoma, cataracts, diabetic retinopathy | Doesn’t cover medical treatment |
Real-life example: You visit because you have persistent eye irritation and blurred vision. During the exam, the doctor detects glaucoma — that portion of the exam is billed via medical insurance. But if, at the same visit, you choose new eyeglasses, the eyewear portion may still use your vision plan.
Common Misconceptions (Myths) — Clarified
“If I have vision insurance, I’m covered for everything eye‑related.”
No. Vision insurance doesn’t pay for eye disease diagnosis or medical treatment.
“Mentioning dryness turned my exam into a medical claim.”
If a medical diagnosis is made, billing may shift to your health insurance.
“I didn’t buy glasses, so my exam shouldn’t have been billed at all.”
A routine eye exam may still be covered through your vision plan even without eyewear purchases.
How VSP & EyeMed Work — Use Your Benefits Before They Expire
At Pikes Peak Eye Care, we accept both VSP and EyeMed vision plans. These plans generally include:
- One annual eye exam
- Frame or contact lens allowance
- Discounts on lens upgrades and add-ons
However — many plans reset on December 31st. If you haven’t used your 2025 vision exam or frame benefit, now’s the time to schedule your visit.
Explore our Eye Care Services to see the full range of what we offer, including routine exams and disease management. You can also view our Eyeglasses & Contact Lenses page to understand how your eyewear needs integrate with your vision plan.
Maximize Your Benefits — Schedule with Us Today
Don’t let confusion hold you back. At Pikes Peak Eye Care, our eyecare team will:
- Help you determine which portion of your visit is billed to medical vs. vision insurance
- Assist in verifying your benefits in advance
- Guide you through the claims process
Whether you need a routine exam or have concerns about eye health, we’re ready to assist. Schedule your appointment now and claim your 2025 vision benefits before they expire.
Frequently Asked Questions
- Q: Does vision insurance cover diabetic eye exams?
- A: No — diabetic exams are medical in nature and billed through medical insurance.
- Q: Can I use both medical and vision insurance in one visit?
- A: Yes. If part of the exam involves a medical diagnosis and part involves eyewear, we can split the billing accordingly.
- Q: What if I don’t know what kind of insurance I have?
- A: No issue. Our staff can review your benefits and help clarify coverage before your appointment.
