If you wear contacts or glasses, you are aware of the high cost of vision care. For example, the average price for glasses frames and lenses is well over $250. But a vision care plan can help make the cost of vision care more manageable. Oftentimes if you have a health insurance plan through your employer they will include a vision plan, but if they do not you generally have the option of acquiring it on your own.
How Private Vision Insurance Works
Medically necessary vision care is often covered by health insurance. For instance, your insurance typically covers ophthalmologist visits if you have injured your eye or exhibit symptoms of an eye condition. Health insurance does not cover routine eye exams or eyesight correction, though: you will need separate vision insurance for that. This type of insurance typically pays for vision correction with elective treatments like LASIK, as well as eye exams and corrective lenses.
As with all other types of insurance, you have to maintain vision care insurance by paying a premium to your insurance provider. The cost of vision insurance varies depending on your plan, provider, and location. Basic plans are typically relatively reasonable, but as you add coverage, costs increase.
What you get for your premium payments can vary greatly. For example, while some vision care insurance plans cover the whole cost of eye exams, others require a copay. In addition, some plans provide an allowance for corrective lenses every 12 or 24 months, while others only cover a portion of the cost, or offer discounts. To receive the full benefits of your plan, you might need to visit a doctor in your plan’s provider network.
There are also things that aren’t covered by vision care plans. For example, if you want upgrades like designer frames, anti-reflective or anti-scratch coating, or progressive lenses, you will probably have to pay quite a bit out-of-pocket.
What Does Vision Insurance Cover?
Eye exams, prescription eyewear (contact lenses or glasses), and medically necessary treatments are all covered in some way by vision insurance, helping to reduce your out-of-pocket costs for them. Additionally, many vision plans include discounts or allowances for photochromic lenses, which are eyewear that blocks ultraviolet light and blue light from computers, as well as prescription lenses with scratch- and anti-reflective coatings.
The majority of vision insurance policies include a set of benefits or discounts on eye care and eyeglasses. Even discounts on Lasik and photorefractive keratectomy (PRK) procedures are offered by some vision insurance plans. These treatments fix vision issues linked to:
- Nearsightedness (difficulty seeing distance)
- Farsightedness (trouble seeing up close)
- Astigmatism (when your eye isn’t completely round)
Even though the prices of PRK and Lasik have decreased over the years with the development of newer technology, they can still be expensive to pay for out-of-pocket.
Types of Vision Care Insurance Plans
The two main categories of vision care insurance are vision benefits plans and discount vision plans.
- Vision Benefits Plans – These are actual insurance policies. You make a premium payment each month, and you are covered for routine eye exams, eyeglasses, contact lenses, and other requirements for eye care. Each time you utilize one of these services, you typically have to pay a copay.
Most vision benefits plans are structured as PPOs. That means you are encouraged to use an eye doctor within the plan’s network, and you are responsible for a larger portion of the cost of your vision care if you receive it out-of-network.
Typically, these plans will cover a certain amount of the cost of vision hardware. For example, your plan might pay $175 for frames, while anything above that amount is your responsibility to pay. LASIK eye surgery and other cosmetic procedures are typically not covered by these vision policies, but some do provide discounts for them.
- Discount vision plans – The monthly premiums of vision benefits plans are significantly more than the cost of a discount vision plan. This is because discount vision plans do not provide the complete cost coverage provided by a vision benefits plan; instead, they just offer you a discount on vision care, which is often between 15% and 35%. Discount vision plans generally offer discounts on eye exams, lenses, and other products that vision benefits plans normally cover.
Who Should Get Vision Insurance
Everyone should have some sort of vision care insurance. Even if your vision is good right now, as you get older, it could gradually get worse. Not only that, but an eye care professional can identify symptoms of eye disorders or injuries. In addition to determining whether you need a prescription or a prescription update. For instance, your eye doctor can identify the following conditions during an eye exam:
- High cholesterol
- Some forms of cancer
Additionally, if you have kids, it’s recommended you take them to the eye doctor at least once a year. The eye doctor can check their vision for any problems or determine whether or not they may need glasses. Pediatricians advise that babies have three vision screenings in their first year to monitor eyesight and eye growth. Early detection of any potential issues can guarantee that any problems are treated quickly and are monitored as soon as possible.
Advantages and Disadvantages of Vision Insurance
Vision insurance has advantages and disadvantages. And whether you should purchase a more expensive comprehensive policy or not may depend on how badly you need it. It can be beneficial to spend more money on vision insurance if you have a history of needing eye exams for medical issues. You might not need to purchase an expensive eye care insurance plan if you simply visit the eye doctor for a basic checkup once a year.
Overall, vision care insurance is affordable and could end up saving you money over time. Particularly if you frequently need corrective lenses or have ongoing eye problems. If you ultimately require eye surgery, it may also lower the cost.
Disadvantages of vision insurance include the possibility that it won’t always cover the services you require. Or that it won’t let you receive treatment outside of its service area. Additionally, it might only carry a select few brands if you like using a particular brand of lenses or specialized lenses and frames.
The cost of vision insurance will vary depending on the coverage offered by various plans and providers. While some private vision insurance companies merely require you to visit an optometrist or ophthalmologist. Others will not pay for your exam if you see a provider who is not in your plan’s network. Pay attention to these details, as well as your copays and deductibles, because choosing the wrong plan for you could result in expensive fees.
For the majority of basic insurance plans, you’ll typically pay around $15 to $20 per month. But if you’re looking to save on eye exams, but aren’t able to afford premiums for private insurance, a discount plan would be a good option. These alternatives let you pay a monthly fee that is cheaper than a normal premium in exchange for discounted eye care services.
Another option to pay for vision care would be using funds in your health savings account (HSA). You just have to ensure that vision services you need are considered a qualified medical expense by your HSA.
If you don’t have vision insurance coverage, you can still pay for your optometrist visit and prescription glasses out-of-pocket. A new patient eye exam normally costs between $150 and $200. Although costs will vary depending on the physician and area.
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How Has the Affordable Care Act Affected Vision Insurance?
Some vision benefit programs were affected by the Affordable Care Act (ACA). If your vision coverage is subject to the new ACA regulations, it won’t have lifetime and annual coverage caps. And the vision plan will have to cover children up to age 26.
But vision plans are regarded as excepted benefits, and are exempt from the new regulations, if they have a limited scope. Vision benefits offered under a separate policy from standard medical benefits or vision benefits that are not an “integral part” of the group health plan are examples of limited-scope plans.
Additionally, pediatric vision care is considered to be a necessary pediatric health benefit under the ACA. This ensures that children under the age of 19 have access to vision coverage. Vision care is not required for people over the age of 19. Since the ACA does not view it as an essential health benefit for adults.
The Bottom Line
Regular eye exams are crucial for maintaining your eyesight and protecting the health of your eyes. Additionally, even if you are among the minority of Americans who do not wear glasses or contacts. Your optometrist will routinely screen for certain disorders.
Despite the fact that many employers provide vision coverage, some don’t. You can locate a vision plan that will cost you considerably less annually than paying for eye care out-of-pocket. Simply because of that, eye insurance is worth the money.