Many of our patients are familiar with routine eye exams: the annual check-ups where we update prescriptions and look for early signs of eye conditions. But there’s another crucial type of eye exam that’s often overlooked: the medical eye exam.
These two types of exams serve different purposes and are treated differently by both eye care professionals and insurance providers. While routine exams focus on maintaining good vision and general eye health, medical exams address specific eye conditions or symptoms. In this blog, we share the key differences between routine and medical eye exams, when each type is necessary, and how they’re typically covered by insurance.
What is a routine eye exam?
A routine eye exam is what most people think of when scheduling an eye exam. These exams primarily focus on checking your vision and your eye health. We recommend these exams for everyone, regardless of whether you currently use vision correction or your age. Many eye conditions develop gradually and without noticeable symptoms in their early stages. Regular exams allow us to detect and address these issues before they progress to more severe, harder-to-treat stages.
At EyeQ Optical, our comprehensive eye exams include:
- Visual acuity testing
- A refraction to determine your prescription
- Screening for common eye diseases
- Updating eyeglass or contact lens prescriptions
These exams are typically recommended annually, though the frequency may vary based on age, risk factors, and previous eye health history.
What is a medical eye exam?
A medical eye exam at EyeQ Optical focuses on diagnosing, treating, or monitoring specific eye conditions or symptoms. These exams are more in-depth and tailored to address particular concerns or manage ongoing eye health issues.
Reasons you might need a medical eye exam include:
- Sudden Vision Changes: Such as blurriness, double vision, or a sudden onset of eye floaters or flashes of light.
- Eye Pain or Discomfort: Persistent irritation, burning, or pain in or around the eyes.
- Red or Swollen Eyes: This could indicate infection or inflammation.
- Diabetes or Other Systemic Diseases: These can affect eye health and require regular monitoring.
- Family History of Eye Diseases: Such as glaucoma or macular degeneration.
- Follow-up Care: For previously diagnosed eye conditions.
Insurance coverage for eye exams
Now that you understand the key differences between medical and routine eye exams, you might be wondering how insurance coverage applies to these different types of exams. Vision plans generally cover routine eye exams and often include benefits for eyewear as well, such as discounts on frames, lenses, or contact lenses. However, when it comes to medical eye exams, you’ll typically need to use your medical insurance. Medical insurance plans usually cover diagnostic exams, treatments for eye conditions, and follow-up visits related to existing eye health issues.
It’s important to note that the type of exam you receive may change based on what your eye doctor discovers during your visit. For example, if your optometrist finds signs of a medical condition during a routine exam, they may schedule a separate medical exam or reclassify the visit as a medical exam. In these cases, your medical insurance would be used instead of your vision insurance.
Whether you need a routine or medical eye exam, the team at EyeQ Optical is here to provide exceptional care and ensure the long-term health of your eyes. We accept a range of vision and medical insurance plans as well as other payment options such as CareCredit and Apple and Google Pay. You can find a list of our approved providers on our insurance page.
If you have questions about which type of exam you need or your insurance coverage, please don’t hesitate to reach out. Call us at 509-922-0633 for more info or to schedule an eye exam in Spokane Valley!