Will My Health Insurance Cover an Eye Exam?

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All health insurance plans that comply with the Affordable Care Act (ACA) must cover eye exams and prescription glasses or contacts for children but insurance companies are not required to cover vision care for adults. As a result, you may need to purchase a separate vision insurance plan to make sure your optometrist visits are covered.

Read on to learn more about when health insurance covers eye exams, what types of vision care are not covered by insurance and what other options exist for making vision care more affordable.

Key Takeaways

  • ACA-compliant health plans are required to cover vision care for children but not for adults.
  • If your health plan doesn’t include vision coverage, you can purchase vision insurance separately to receive coverage for eye exams, glasses or contacts and potentially other types of vision care.
  • Both health insurance and vision insurance generally exclude coverage for LASIK eye surgery.
  • The monthly premium for vision insurance typically ranges from about $5 to $30.

Why Won’t Health Insurance Cover an Eye Exam?

Even though eye exams are a type of preventive health care, ACA Marketplace health plans are not required to cover vision care for adults.[1] While a standard health plan will likely cover treatments for a medical condition involving the eyes such as glaucoma or cataracts, it may not cover routine care such as getting an eye exam or purchasing glasses or contacts.

You should note that, although Marketplace plans don’t have to cover adult vision care, they do have to cover vision care for children.[1] If your child receives a vision screening from an in-network provider, a Marketplace plan will cover it with no copay or coinsurance regardless of whether you’ve hit your yearly deductible.[2]

What Type of Insurance Do You Need for Eye Exams?

Vision coverage may be included in your health plan or you may need to purchase a separate vision insurance plan to obtain eye exam coverage. Standalone vision plans are not available on the Health Insurance Marketplace but you should be able to buy one directly from a private health insurance company.[1] You can also sign up for vision insurance through some state-run health insurance exchanges such as Covered California.[3]

How Is Vision Insurance Different From Health Insurance?

Unlike health insurance, vision insurance generally doesn’t cover surgeries or medications for eye-related illnesses or injuries and instead exclusively covers routine care. As a result, standalone vision insurance tends to be far cheaper than medical insurance. Vision insurance usually costs around $5 to $30 per month, while the average nationwide cost of health insurance is $477 per month if you opt for a Marketplace benchmark plan.[4][5]

What Is Covered by Vision Insurance?

Vision insurance plans predominantly cover basic eye care such as undergoing an annual eye exam and getting prescription contact lenses or eyeglass frames and lenses. However, some plans may include broader coverage that extends to transition lenses, prescription sunglasses and eyewear accessories.[6]

Conversely, LASIK eye surgery generally isn’t covered by health insurance or vision insurance since insurance companies typically don’t consider it to be a medically necessary procedure. That said, some vision insurance companies offer discount coupons that can help make LASIK surgery more affordable.[7]

Are Insurance Alternatives Available for an Eye Exam?

If you are struggling to find a cost-effective vision insurance plan, you may want to look into the numerous organizations that offer free or low-cost vision care such as EyeCare America for senior citizens, InfantSEE for babies or Lions Club International for people of all ages. Additionally, many optometry schools offer cheap vision care if you are willing to have your eyes examined by a supervised student.[8]

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Do I need vision insurance if I already have health insurance?

Even if you already have health insurance, you may need additional vision insurance since Marketplace plans aren’t required to include vision coverage for adults.[1]

Does Medicare cover eye exams?

Original Medicare doesn’t cover routine eye exams but 99% of individual Medicare Advantage plans cover vision care.[9][10]

Does health insurance cover diabetic eye exams?

If you have diabetes, your health plan may cover eye exams since you may be at a higher risk for developing eye diseases like diabetic retinopathy. For example, Blue Cross Blue Shield of Massachusetts health plans cover one diabetic eye exam per year along with medically necessary follow-up visits.[11]

Does health insurance cover prescription glasses?

Some medical insurance plans cover prescription glasses for adults but you may need to purchase a separate vision insurance plan to receive guaranteed coverage for prescription glasses.

When does health insurance cover eye exams?

All Marketplace health insurance plans are required to cover eye exams for children.[1] However, you will need to check your specific policy details to determine whether adult vision care is covered by your plan.


  1. HealthCare.gov. “Vision Coverage - Glossary.” Accessed May 24, 2024.
  2. HealthCare.gov. “Preventive Care Benefits for Children.” Accessed May 24, 2024.
  3. Covered California. “Adult Vision.” Accessed May 24, 2024.
  4. GoodRx. “Is It Worth Getting Vision Insurance? Costs and Benefits.” Accessed May 24, 2024.
  5. KFF. “Average Marketplace Premiums by Metal Tier, 2018-2024.” Accessed May 24, 2024.
  6. Anthem. “Is Vision Insurance Worth It?” Accessed May 24, 2024.
  7. GoodRx. “LASIK Isn’t Covered by Insurance, But There Are Discounts.” Accessed May 24, 2024.
  8. The EyeDoctors Optometrists. “A Guide to Eye Exams Without Insurance.” Accessed May 24, 2024.
  9. Medicare.gov. “Routine Eye Exam Coverage.” Accessed May 24, 2024.
  10. KFF. “Medicare Advantage 2024 Spotlight: First Look.” Accessed May 24, 2024.
  11. Blue Cross Blue Shield of Massachusetts. “Diabetic Eye Exams.” Accessed May 24, 2024.

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