When you visit your eye doctor for a comprehensive exam, you may notice an additional charge on your bill for something called a refraction. This often raises questions: What exactly is a refraction? and Why isn’t it covered by my insurance?

Let’s break it down so you understand what a refraction is, why it matters for your vision, and why insurance companies typically don’t pay for it.

What Is a Refraction?

A refraction is the part of your eye exam that determines whether you need glasses or contact lenses—and if so, what your prescription should be.

During a refraction, your doctor uses a phoropter (the instrument with all the lenses that you look through) to measure how light focuses inside your eye. By asking questions like, “Which is clearer, 1 or 2?” your doctor determines the exact lens power needed to give you the sharpest vision possible.

Refraction is essential for:

• Diagnosing nearsightedness, farsightedness, astigmatism, and presbyopia
• Updating your glasses or contact lens prescription
• Assessing changes in your vision over time

Why Is a Refraction Important?

A refraction does more than just help you see clearly. It’s also an important tool for your eye doctor:

• It helps distinguish whether blurred vision is caused by a simple change in prescription or by a medical eye condition such as cataracts or macular degeneration.
• It provides a baseline measurement for monitoring vision changes at future visits.
• It ensures that your glasses or contact lenses are accurately prescribed, which impacts your daily comfort, safety, and quality of life.

Without a refraction, your doctor cannot give you a prescription for glasses or contacts—and you may be left struggling with blurry or strained vision.

Why Isn’t a Refraction Covered by Medical Insurance?

Here’s where the confusion often arises, a refraction is considered a vision service, not a medical service.

• Medical insurance covers diagnosis and treatment of eye diseases or injuries (like glaucoma, cataracts, eye infections, or diabetic retinopathy).
• Vision insurance (a separate type of coverage) may cover refractions, glasses, and contacts, since those services are considered part of routine vision care.

At North Texas Ophthalmology Associates, we want to be transparent:

• We do not accept vision insurance.
• The cost of a refraction in our office is a flat fee of $40.00, which is collected at the time of service.

Because a refraction is performed to determine your glasses or contact lens prescription, most medical insurance plans classify it as non-medical and do not cover it—even if it is performed during a medical eye exam.

Frequently Asked Questions About Refractions

1. Do I need a refraction if I don’t want new glasses?
Yes. Even if you are not planning to purchase new glasses, a refraction helps your doctor determine whether changes in your vision are caused by a prescription issue or a medical condition. Skipping it could mean missing early signs of eye disease.

2. Does Medicare cover refractions?
No. Medicare considers refraction a “non-covered service.” This means you are responsible for the fee out-of-pocket.

3. Can I use my vision insurance for a refraction?
We do not accept vision insurance at our office. Some vision plans do cover refractions, but since we only bill medical insurance, the $40 fee is collected directly from patients.

4. Why is the refraction billed separately from my eye exam?
Because medical insurance does not cover it, refraction must be itemized and billed separately—even when it’s performed as part of a medical eye exam.

5. How often should I have a refraction?
Typically once a year, or more often if you notice changes in your vision. Annual refractions ensure your prescription is up-to-date and help your doctor track your eye health.

Key Takeaway

• A refraction measures your prescription for glasses or contacts.
• It is essential for clear vision and distinguishing vision changes from medical eye conditions.
• It is not covered by medical insurance because it is considered a vision service.
• At North Texas Ophthalmology Associates, we do not take vision insurance, and the cost of a refraction is $40.00.

👉 If you have questions about your exam, coverage, or the cost of services, our team is happy to guide you. Schedule your next comprehensive eye exam today and let us help you see clearly! Visit us at www.ntoaeye.com or call us at (940) 240-8400.