What is the Difference between a Routine Eye Exam and a Medical Eye Exam?

Posted by Maria C. Scott, M.D.

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Jun 1, 2015 11:30:00 AM


 If you're scheduled to have an eye exam in the upcoming days or weeks, you may be wondering what exactly this will entail. Usually, your eye exam is classified by your insurance provider as either a "routine" or "medical" eye exam. However, this often has nothing to do with what the actual contents of the eye exam will be. Keep reading to learn the difference between these two terms.

Routine vs. Medical

Ultimately, what determines whether your eye exam is classified as "routine" or "medical" depends on two factors: the reason for your visit and your final diagnosis. If you're only at the eye doctor for a standard checkup and the doctor doesn't find any significant issues, then the exam will be categorized as routine. Similarly, if the doctor finds that you have vision problems stemming from an eye imperfection like farsightedness or astigmatism, the exam will also be categorized as routine. However, if you have a medical problem like cataracts, glaucoma, or an infection, then the exam will be categorized as medical in nature.

Insurance Differences

So how does this distinction between routine and medical eye exams affect you? To begin with, medical insurance plans may not cover eye exams that have been judged to be routine. To cover part or all of the costs of a routine exam, you may need a specialized vision insurance plan. However, some medical insurance plans do cover a routine eye exam at infrequent intervals.

Secondly, you should be aware of what is known as a refraction fee. If you have concerns about your eye health, but you would also like your vision to be checked, then your doctor may charge you for the medical exam and the checkup separately. As already mentioned, many medical insurance companies will cover only the medical exam, leaving you to pay the refraction fee out-of-pocket.


Staying informed about the costs and options of your medical care is crucial. Before going in for your eye examination, determine whether it is likely to be classified as a routine or medical exam. Always check with your insurance provider to see what is covered and not covered under your plan, as well as any possible deductibles and co-pays.

A reminder if you are interested in LASIK, check out our guide. 



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Dr. Maria Scott is the founder and medical director of Chesapeake Eye Care and Laser Center and the medical director of TLC Laser Eye Center Annapolis. She is one of the nation’s most respected cataract and refractive surgeons. With a reputation for excellence that extends from her patients to colleagues throughout the medical community, her passion to improve her patients’ quality of life is evident throughout every aspect of the practice. Always ahead of the curve, she is often the first to offer new techniques and treatments to her patients and was the first person to offer LASIK in Annapolis. Focused on results, she has one of the lowest enhancement rates for LASIK patients in the country.

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