1902 N Sandhills Blvd., Suite A & E
Aberdeen, NC 28315
Optical Shoppe:
1902 N Sandhills Blvd., Suite E
Aberdeen, NC 28315
Pediatric Ophthalmology - General Optometry 910-692-2020

What is a refraction? Is it covered under Medicare? Is it covered under commercial insurance?

September 27, 2016

A refraction is the part of the office visit that determines the eyeglass prescription. Many times this involves the comparison question “which choice is clearer, choice one or choice two?” as different lens combinations are presented to the patient.

Medicare does not consider a refraction to be a “medically necessary” service, and therefore Medicare will not pay for this part of the examination. Some secondary or vision insurance plans, however, will cover this service.

It is important to remember that the patient’s insurance coverage is an agreement between the patient and their insurance company; NOT between the insurance company and the doctor.

Remember, insurance “coverage” does not necessarily mean insurance “payment”. Many health plans have required copayments and deductibles that must be met before they pay anything towards the patient’s bill.

In general, it is best for patients with commercial insurance (whether primary or secondary) to check with their insurance carriers (calling the numbers printed on the back of their insurance cards) BEFORE their office visit to:

  1. determine if they have vision benefits (and what those benefits are)
  2. determine if our doctors are participating providers in their plan
  3. determine whether or not refractions (determination of eyeglass prescriptions) are covered

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