Insurance companies classify eye exams into two categories: Vision Exam and Medical Eye Exam. A diabetic eye exam is considered a Medical Eye Exam and will generally be covered by your medical insurance.
A Medical Eye Exam (usually covered by medical insurance)
- Involves a medical condition related to your eyes
- Is medically necessary for the diagnosis and treatment of eye diseases and conditions of the eye
- Covers pre-existing conditions requiring follow-up care, regular monitoring, and referral to a surgeon or specialist
- Does not cover routine eye care (eyeglasses, contacts, services related to eyeglasses and contact lenses)
- Does not require a vision benefits rider on your medical insurance
A Vision Exam (often not covered by medical insurance)
- Is a “well-eye” exam/routine vision exam to determine the need for corrective lenses and to evaluate overall eye health
- Includes eyeglasses, contact lenses, and screening for eye diseases and disorders
- Does not involve any medical decisions or management
We know the insurance side of healthcare can be confusing. If you ever have questions, we are here to help.