Clarity About Your Vision Benefits

BayCarePlus® partners with EyeMed to provide your vision benefits. To use this benefit for routine eye exams and/or to get eyeglasses or contact lenses, you must see a vision care provider who’s in the EyeMed network. This is true even if the eyeglasses and contact lenses are the result of a change in your eyes due to a medical condition—for example, after cataract surgery.

Here’s a general overview of the differences between an optometrist and an ophthalmologist and when to visit each of them.
Optometrists Ophthalmologists

Optometrists examines eyes and treats and diagnoses eye problems.

  • Uses your vision benefits
  • Select a provider from EyeMed network using the Vision Provider Locater on EyeMedVisionCare.com.
  • Used for routine eye exams, glasses and contacts
  • Routine eye exam: $0 copay
  • Routine eye exam with retinal imaging: $0 copy plus an additional fee for retinal imaging

Ophthalmologists treat and prevent medical disorders of the eye, including surgery.

  • Uses your medical benefits
  • Find an ophthalmologist on BayCarePlus.org:
    • Search “Ophthalmology” from the Provider Search Directory.
  • Specialist, with a specialist copay
  • Used for medical treatment of eye disorders including surgery, i.e., diabetic-related eye conditions, amblyopia (lazy eye), retinal conditions, and cataract, glaucoma and retinal surgeries
  • A referral is required, except for members of the BayCarePlus Premier plan. 
If an ophthalmologist performs a procedure, such as a cataract surgery, and refractions are required, members must go to an in-network optometrist for their refraction, or it won’t be covered. If you have diabetes or a medical eye problem such as cataracts or glaucoma, contact your PCP. A referral is required, so they’ll refer you to a participating ophthalmologist or optometrist unless you’re a member of the BayCarePlus Premier plan. Medical eye exams require a copay.

For information about covered medical screenings and exams, see your Evidence of Coverage booklet or go to your Member Portal at Member.BayCarePlus.org.

Read more from EyeMed, our vision partner: Eye Site On Wellness: How to choose an eye doctor

Important Disclaimers

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**Referrals are required for home health and occupational, speech and physical therapies.

For accommodations of persons with special needs at meetings call (877) 549-1741 (TTY: 711).

BayCare Select Health Plans is an HMO plan with a Medicare contract. Enrollment in BayCare Select Health Plans depends on contract renewal. All BayCare Select Health Plans include Part D drug coverage.

To enroll, you must have both Medicare Parts A and B and reside in the plan service area.

You must continue to pay your Medicare Part B premium. Enrollment in a BayCare Select Health Plan may be limited to specific times of the year.

Members must use plan providers except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from BayCare Select Health Plans, neither Medicare nor BayCare Select Health Plans will be responsible for the costs.

Information on our utilization management processes, including prior authorization, concurrent review, post service review and appeals, can be found online at Member.BayCarePlus.org.

Every year, Medicare evaluates plans based on a 5-star rating system.

BayCare Select Health Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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