Does Health Insurance Cover Eye Exams

Eye exams are important for maintaining good vision detecting early signs of eye diseases. However many people are unsure whether their health insurance covers these exams. Here are some things to know about eye exam coverage.

Types of Health Insurance Plans

There are different types of health insurance plans that cover eye exams to varying degrees. These include:

• Private health insurance plans
• Medicare
• Medicaid
• Children’s Health Insurance Program (CHIP)

Private Health Insurance Plans

Most private health insurance plans cover routine eye exams although the extent of coverage may vary. Some plans may require you to go to an eye doctor within their network while others may allow you to choose any eye doctor. However some private plans may not cover eye exams for purely cosmetic purposes such as LASIK surgery.

Medicare

Medicare Part B covers one eye exam per year for people with certain risk factors for eye diseases such as diabetes or a family history of glaucoma. If you’re eligible for this coverage you will generally pay 20% of the Medicare-approved amount for the exam.

Medicaid

In some states Medicaid covers vision services including eye exams for eligible beneficiaries. However the extent of coverage may vary by state some states may only cover certain types of eye exams. Check with your state’s Medicaid program for details.

Children’s Health Insurance Program (CHIP)

CHIP covers routine eye exams vision services for children up to age 19. This includes eyeglasses contact lenses preventive care for conditions such as lazy eye.

Other Factors to Consider

Even if your health insurance plan covers eye exams there may be other factors to consider. For example some plans may limit the frequency of covered exams or may only cover certain types of exams. Additionally if you have a high deductible plan you may need to pay out of pocket for the exam until you meet your deductible.

The Bottom Line

In general most health insurance plans cover routine eye exams to some extent. However it’s important to understthe specifics of your coverage including any limitations or requirements. If you’re unsure check with your insurance provider or eye doctor. Finally remember that regular eye exams are an important part of maintaining good vision overall health. So even if your insurance doesn’t cover the full cost of the exam it may be worth scheduling one anyway.