Vision Insurance Basics

Vision Insurance Basics
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Vision insurance is one of those insurance coverage options that might or might not make financial sense, depending on the nature of your needs. It pays toward most routine eye exams, and for eyeglass frames, eyeglass lenses and contact lenses, but it might not have your back if you develop glaucoma or something that requires care by an MD. A vision care plan is intended to pay for testing by an optometrist and products that allow you to see better, and for detection of more serious eye issues, but your vision benefits probably won't pay for further care if an issue or eye disease is discovered.

What Does Vision Insurance Cover?

What is vision insurance? It’s a plan that's designed to provide additional, supplemental coverage to your medical insurance plan. It will pay for at least some of the costs associated with vision correction: those glasses (both frames and lenses) and contact lenses, and for the exam that will raise a flag that you need these things. It won’t pay for the entire cost, however. You’ll have to come out of pocket for at least some of the expense.

Vision insurance covers preventative care and prescription vision aids. Some isolated plans will also cover elective vision corrective surgery, such as LASIK, but this is the exception rather than the rule. Plans that do cover LASIK might only give you a discount on the cost of the procedure because it’s not considered a medical necessity.

What’s Not Covered?

Vision insurance does not cover care and treatments for diseases of the eye because your traditional health insurance is responsible for paying these types of claims. The same goes for the treatment of eye injuries. There’s a line in the sand between these two types of policies because they cover separate issues. Health insurance won’t pay for vision exams or corrections, although an exception can be made if the exam diagnoses a medical problem related to the eyes.

Vision insurance might or might not cover enhancements. Some plans cover things like glare protection or progressive lenses on those eyeglasses, but others do not. It depends on your policy.

How Much Does Vision Insurance Cost?

These limited or supplemental policies are least expensive if you’re lucky enough to have access to one through your employer's benefits package. It might just be a matter of a couple of extra dollars a month on top of what you’re already contributing to your employer-sponsored health insurance coverage to add a vision insurance rider. The cost can be shared by your employer.

Otherwise, you can probably plan on spending anywhere from about ​$70 to $170 a year​ (​$6 to $14 a month​), depending on the type of plan and insurance benefits you select, and it can vary by state as well. You’ll also be responsible for co-pays, which typically run from ​$10 to $30​ per visit for benefit plans, and you’ll most likely have to pay a deductible and out of pocket costs as well. The cost of glasses or contacts is usually only covered up to a certain percentage. You’ll have to personally pay the balance. "Discount” plans are those that simply cut you a break on how much you’ll pay for exams, glasses and contacts, but either way, you’ll be paying a lot of the costs yourself in addition to your monthly premiums.

The AARP indicates that seniors can dodge the cost of an eye exam because EyeCare America offers exams free of charge through its Seniors Program. The program is provided by the American Academy of Ophthalmology and it's manned by local volunteer ophthalmologists. It's available to those aged 65 or older. EyeCare America also offers a glaucoma program.

Shop around if none of these options work for you. Ask various vision care centers and eye doctors for their prices, and find out if they offer any cash discounts if you pay for your care yourself rather than put in an insurance claim. Then compare what it would cost you for care out of pocket to what vision insurance premiums, copays and deductibles would run you. You might be better off simply paying for this type of care yourself, particularly because your health insurance will kick in if you’re diagnosed with a serious disease.

Do You Need a Vision Insurance Plan?

There’s no arguing that we can all benefit from a vision exam once a year or so, if only to screen for serious conditions. You probably already know you need eyewear if you find yourself squinting to see, but some serious conditions can lurk under the radar. According to the AARP, approximately ​two percent​ of people age 40 or older have glaucoma, and age-related macular degeneration is the primary cause of vision loss in people over age 50.

About ​92 percent​ of those over age 65 need eyeglasses, so you might want to consider coverage if you’re in this age group and you don’t qualify for EyeCare America for some reason. The number drops to about ​60 percent​ of the American population overall if you take age out of the equation. This means that approximately ​four out of every 10 Americans​ have perfect 20/20 vision, or close to it. You probably don’t have much to gain from a vision insurance policy if you fall into this category, although an eye exam can wave a red flag to the existence of a serious condition, so you don’t want to skip it even if you think you see just fine. It’s particularly important if you have a family history of eye health issues or conditions that can be detected by an eye exam.

Otherwise, you might want to try to gauge just how much vision care you’re likely to need per year. You might be better off coming out of pocket for care if you anticipate seeing an eye doctor and updating your eyeglass or contact prescription once per year or so, particularly when you consider those co-pays, deductibles and percentage limits that can apply to services and products. Add these costs to the cost of your premiums to see where you stand financially for one visit per year, keeping in mind that your medical insurance should have you covered if anything serious crops up.

Where to Get Coverage

Check with your employer first if you think you need this type of insurance coverage. Find out if it’s available as an add-on to your existing health insurance plan. Otherwise, consider looking for a “stand-alone” plan on your own. You can search online, or contact an insurance company or agent to find out what, if anything, they offer, and for how much. Your state’s department of insurance might also be able to provide some guidance.

Another option is to touch base with your health insurance provider, or even your dental insurance provider if you have one. You might be able to add vision coverage to either of these plans at a reasonable cost.

Basic Medicare doesn’t provide vision coverage, although some Medicare Advantage plans do. And the Health Insurance Marketplace isn’t likely to be much help for this type of insurance, either. These plans cover children under age 19, at least to some extent, but they rarely include vision coverage for adults. And you’ll still probably have to pay a deductible and/or co-pay for your children for anything other than vision screening, which is considered to be preventive care. This can vary by plan.

What you won’t find on the Marketplace are stand-alone plans, at least not unless you happen to live in California, Nevada, Idaho, Colorado or the District of Columbia. These states’ exchanges have established partnerships with stand-alone vision service plans, or VSPs. You can link directly to the plan providers from your state’s website.