As you would imagine, vision insurance pertains to eye care. What you might not know is that it focuses (no pun intended) primarily on wellness instead of injury. It covers eye exams, glasses (lenses and frames), and contact lenses – although in some policies, more advanced procedures such as Lasik surgery may be partially covered or discounted. The more serious health risks posed to your vision -- such as glaucoma or cancers of the eye – will be covered by your standard health insurance policy, not by a vision policy.
Vision insurance is available in two different formats:
- Benefits Plan – Just like a health plan, you pay a premium that grants you access to a network of eye care specialists, and care is provided with a relatively small co-pay fee each time the services are used. Glasses and contact lenses are usually covered up to a certain dollar limit; other services may be discounted.
- Discount Plan – With a premium or membership fee, eye care specialists within the group offer you discounted rates for all services that are covered, including exams, glasses and contact lenses.
Often, employers will offer group vision coverage as part of their health benefits packages, which is usually cheaper than buying a stand-alone vision coverage plan. You may also be eligible for group coverage through Medicare/Medicaid, or various associations.
You may be able to purchase a combined package as part of your healthcare plan under the new healthcare exchanges, depending on the type of health insurance you purchased and the carrier you use. Otherwise, you can buy a stand-alone policy for yourself or your family through several carriers such as Humana or VSP.
As you search for the best plan for your family, keep in mind that pediatric vision care is one of the essential health benefits for qualified health plans under the Affordable Care Act, but adult vision insurance is not mandated.
Do you even need a plan at all? Vision insurance rates vary by area and insurer, as well as the degree of coverage. Therefore, the only way to answer the question is to compare your options with and without insurance.
Without insurance, you are likely to need one eye exam per year (generally around $50-$75). If your vision does not need correction, then that is your only relevant expense. Glasses can run anywhere from $100-$500 and even more if you want designer frames. Contact lenses will cost around $150-$250 per year. So, let’s say on the low side, $300 in out of pocket costs per year, and on the high side $825 annually.
Then compare your likely costs with several insurance plans and the glasses, frames and contacts that you prefer. Quotes are available online from several vendors. Include the annual premium, the co-pay for exams, the co-pay or overage for glasses and contact lenses, and the discounts you will receive on second pairs or alternate products such as prescription sunglasses.
Make sure you check the policy to understand exactly what is covered – and what is not. For example, if your policy covers up to the first $125 on glasses or contact lenses, does that mean you can get $125 off of each one, or only off one? If you need both glasses and contact lenses, you may want a different policy. Other considerations are the type of lenses and frames covered, and the policy for accidental breakage of your glasses.
Finally, make sure your preferred eye care specialists are part of your provider network – and if not, factor out-of-network costs into your calculations.
If you don’t require vision correction, then you don’t require vision insurance. Eye exams can be paid for out of pocket, or through any employer program that you may have. However, if you have vision correction needs, there is probably a worthwhile policy available to you.
Of course, there is one important caveat – if you buy vision insurance, see to it that you use it (pun intended).