Eye care services are largely provided by two professional groups–optometrists and ophthalmologists. Professional rivalry between the two exists mainly because both are in direct competition for patients with routine diagnostic and treatment needs. With the advent of Medicare and Medicaid, a substantial amount of health care services rendered to the elderly has been financed by the federal government. The use by the elderly of eye care services and the cost of such services are influenced by Medicare reimbursement policies. Medicare specifically excludes routine eye care and refractive services, but includes diagnosis and treatment of ocular disease. This article examines the impact of eye care benefit exclusions and restrictions and their effect upon the use of ophthalmological and optometric services by the elderly.