07/06/2026
Great question! It seems like the answer would be no vision insurance, no exam, right? Wrong!
Here is the breakdown: Vision insurance pays towards 3 things.
1. Refraction. The necessary part of the eye examination where the Doctor determines weather or not your vision has deteriorated or changed (Where they do the whole 1 or 2, 1 or 2, thing to get the new updated prescription)
2. Comprehensive examination. This is where the Doctor looks in the back of your eye to check the nerves, veins, and internal components for things like diseases, glaucoma, macular degeneration, etc.
3. Hardware. Glasses or contact lens benefits.
Where does medical insurances step in? They can pay for the comprehensive examination. If you have dry eyes, diabetes, or any other medical thing going on in your eye, you exam falls under an insurance medical code. The refraction, costs $45 at the time of service, which matches what a lot of places change for that part of the exam too. So really, the big change we see when we have vision insurance or not, is if you have glasses benefits. So, do not let not having vision insurance stop you from getting an eye examination! Insurances generally consider comprehensive eye examinations as medically necessary and will accept claims for that.