Strictly speaking, an eye doctor is an ophthalmologist, a physician trained in the diagnosis and treatment of diseases of the eye, including cataracts, glaucoma, or problems resulting from diabetes or high blood pressure. Ophthalmologists prescribe eye medications and perform eye surgery, but often prescribe eyeglasses or contacts as well.
An optometrist, also commonly referred to as an eye doctor, is not a physician, but rather a trained professional licensed to examine patients for visual defects, and to prescribe glasses and contact lenses. The glasses themselves are made by an optician.
An optometrist usually offers a lower examination fee than an ophthalmologist. If you’re healthy, have no insurance, and only need a pair of glasses, see your local optometrist (or the one employed at your local superstore).
If you have insurance, check your policy to decide what type of eye doctor to see. If your coverage offers an annual eye exam, most likely this is through an optometrist on your plan.
If, however, you have a medical problem, it may cost you less to see an ophthalmologist. Ophthalmologists are covered under your insurance (including Medicare) the same as any other specialist, such as a cardiologist. (Traditional Medicare does not cover optometrists, though it is possible your secondary insurance may pay.) Any person with high blood pressure or diabetes has a valid reason to see an ophthalmologist.
Physicians and optometrists both refer patients to ophthalmologists for a variety of conditions including certain infections, injuries to the eye, uncorrectable visual problems, lazy eyes, glaucoma, cataracts, persistent styes, macular degeneration, diabetic or hypertensive retinopathy, iritis, and droopy eyelids.
Prescription eye medications are covered under both insurance and Medicare the same as any other prescription medication. Medicare does not pay for routine vision testing, eyeglasses, or contact lenses. They do cover “standard frames” after cataract surgery, although patients may choose to pay the difference for an upgrade to a “deluxe frame” of their own choosing.
Even if you have no disease of the eye other than poor vision, your insurance may cover a visit to a medical eye doctor. Again, check your policy first for coverage and your list of in-network physicians (ophthalmologists), optometrists, and opticians.