Know before you go: Where’s the best place to go for an eye exam

Your eyesight is precious. Periodic eye exams are an important step in preserving your vision long term. In addition to correcting your vision, during an eye exam your eye doctor can detect any eye disorders at an early stage, when they are more easily treated and their progress can possibly be reversed.

But navigating eye care benefits can be confusing. The first thing to understand is that there are three different types of eye care providers: opticians, optometrists, and ophthalmologists.

Opticians have a 1- or 2-year degree certification, and specialize in filling lens prescriptions. Once you have your eyeglass prescription in hand, an optician will assist you with lens and frame selection and fitting. An optician is not qualified to conduct eye exams.

Both optometrists and ophthalmologists are qualified to conduct eye exams, where they will not only check your vision, but will also check your eye health for conditions such as glaucoma and macular degeneration.

What’s the difference between optometrists and ophthalmologists?

Optometrists are doctors of optometry (OD) with four years post-graduate doctoral training, and they can diagnose and treat certain non-complex eye conditions, including writing prescriptions. They cannot perform surgery.

Ophthalmologists are medical doctors (MD or DO) who went through four years of medical school plus specialized training in ophthalmology. They can diagnose and treat complex medical eye conditions and perform surgery.

Which should I go to for my eye exam, an optometrist or an ophthalmologist?

Doctors available through vision plans are usually optometrists. If you have a vision plan, it is usually better for you to go to a participating optometrist, for several reasons:

  • Optometrists specialize in eye exams for healthy people who may have some loss of vision, as usually occurs as we get older. That’s what they do all day, every day. It’s their area of expertise.
  • With most vision plans, you pay a lower copay than if you go to an eye doctor who is a medical doctor through your medical plan.
  • Importantly, many medical insurance plans will not cover your visit to an MD/DO eye
    doctor for the purpose of a routine eye exam.
  • Convenience — very often optometrists will share an office with an optician they trust, so you can choose your frame and lenses during the same visit – a one-stop shop. Also, locations with optometrists are more prevalent and more conveniently located.

An eye doctor is listed in my vision plan, but their office is telling me they will only accept my medical plan. What should I do?

Use your vision benefit plan where possible, not your medical plan. When you call to make an appointment, some optometrists might tell you that they prefer to use your medical health plan, not your vision plan. Don’t be afraid to insist that you will be using your vision benefit plan.

Finally, understand your coverage before you go. Check online with your vision benefit plan before you go to the appointment so you know what’s covered and what’s not, and what your costs might be.

No Surprises Act Notice and Disclosures

Download PDF of No Surprises Act Notice and Disclosures

Rights and Protections Against Surprise Medical Bills for Emergency Services and Certain Services from Out-of-Network Providers at an In-Network Hospital or Ambulatory Surgical Center

Plan participants are protected from surprise billing, also called balance billing, for emergency care and claims from out-of-network providers that rendered certain services at an in-network hospital or in-network ambulatory surgical center.

Emergency Services

The most a provider or facility may bill a participant is the plan’s in-network cost-sharing amount (such as copayments and coinsurance). The provider cannot balance bill for emergency services. This includes services after a patient has been stabilized, unless the patient provides written consent and gives up protections from being balance billed for post-stabilization services.

Certain Services from out-of-network providers at an in-network hospital or ambulatory surgical center

Out-of-network providers at an in-network hospital or in-network surgery center that provide emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeons, hospitalists, or intensivists services, are not permitted to balance bill. They are not permitted to ask a patient to consent to give up protections against balance billing.

Out-of-network providers of other services at in-network facilities may only balance bill a participant if the participant gives written consent and gives up the protections from balance billing.


For information and complaints related to balance billing, contact the U.S. Department of Health & Human Services at 1-800-985-3059 or visit for more information about the No Surprises Act, payment disputes and patient rights under federal law.

Visit for more information about your rights under federal law.

More about the No Suprises Act

No Surprises Act introduces a new term called the Qualifying Payment Amount, or QPA, and defines it as the plan’s median contracted rate — the middle amount in an ascending or descending list of contracted rates. The most a provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). The law requires providers to accept the QPA as payment in full for out-of-network emergency services. In addition, certain services provided by out-of-network providers at in-network facilities are also subject to these protections unless the patient provides consent to be billed.