A refraction is the test that is performed to determine your eyeglass prescription. A refraction may be performed by either the doctor or a technician, and typically involves questioning along the lines of, “Is 1 better than 2?” Medicare and many other insurance plans consider a refraction to be routine medical care not covered under their medical coverage, so this amount is charged separately and is paid directly by the patient. Medicare secondary insurance plans will also not pay the charge since it is not a Medicare-covered service, so the $45.00 fee is to be paid by the patient.