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
  • 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
    • 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

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