Vision Care Insurance Plan – What Does It Cover and Is It Worth the Cost?
My most recent visit to the eye doctor cost me $120 out of pocket for the wellness exam and $285 for a pair of progressive lenses. Trying to save money, I opted to keep my old frames. Still, $405 was the minimum I could spend to keep up with my declining eyesight.
It turns out that if I’d had the right vision insurance, I could have paid $10 for the exam, around $100 for the lenses, and gotten a $130 allowance to go toward new frames — for a total of around $110 out of pocket if I didn’t exceed the frame allowance. Plus, I could have gotten 20% off another set of glasses, such as sunglasses.
That’s why I started taking a serious look at vision insurance. If you wonder if insurance is worth the extra cost and hassle, it’s time to review whether vision insurance is right for you. Even if you made your mind up years ago, inflation or life changes might give you a reason to reconsider a policy.
What Is Vision Care Insurance?
Vision insurance shifts the costs of vision exams, glasses, and contacts, to the insurer in exchange for a monthly (or annual) premium. A vision plan’s coverage can range from basic to comprehensive. Some also reduce the cost of elective correction surgeries like LASIK and photorefractive keratectomy.
If the doctor wrote a prescription requiring new corrective lenses, you would pay the copay or coinsurance for glasses or contacts. Usually, people who prefer scratch-resistant, blue-light filtering, and anti-glare coatings must pay for the upgrade out of pocket, though some policies cover those as well.
Like health insurance, vision insurance relies on network providers to keep costs down. Going to an out-of-network provider limits the usefulness of vision insurance.
How Vision Care Insurance Works
Vision insurance policies are much less complicated than health insurance plans because it’s limited to one body part. Additionally, the plans only pay for services you need yearly at most.
Fortunately, vision insurance doesn’t have a yearly deductible you must pay before benefits kick in. Therefore, your out-of-pocket costs are limited unless you buy expensive frames and several lens enhancements.
To use vision insurance, start by visiting your optometrist. Next, pay a copay for the eye exam, and the insurance pays the balance to the provider. Then, the insurance pays a limited amount for frames, lenses, and contacts at your optical retailer.
The policy sets the dollar limits it pays, and you pick up the out-of-pocket for costs beyond that.
Usually, vision insurance covers necessary vision care once every 12 months. So you have to pay out of pocket if you need a follow-up visit. And it may cover things it considers unnecessary less frequently. For example, it may only cover new frames every two years.
Some only pay for basic lenses with few enhancements like progressive focus, specialized coatings, and polycarbonate upgrades. Others may pay for more.
What Does a Vision Plan Cover?
A vision insurance plan typically includes the following:
- Vision tests and eye health exams
- Eyeglass frames
- Eyeglass lenses
- Contact lenses
- Lens enhancement
- Discounts on corrective surgery
Each element of vision care has its own copay.
For example, the VSP standard vision plan has a $15 exam copay and a $25 copay for prescription lenses, including single, lined bifocal, and trifocal lenses.
However, there’s an additional copay for each lens enhancement and a maximum $150 allowance for frames or contacts.
Note that most vision insurance pays for either glasses or contacts, not both. Additionally, many policies have a discount program for a second pair of glasses or sunglasses, contacts, and laser correction.
Vision insurance coverage levels vary depending on overall plan coverage, which is tied to your premium, or the amount you pay monthly or yearly for insurance. Policies with higher premiums have more coverage.
For example, all plans limit how much they pay for frames, but they do it differently. Lower-premium plans exclude frames, while higher-premium plans cover up to $200 or more. And most mid-premium and high-premium policies have copays for lens enhancement or surgical eye correction benefits, but low-premium plans don’t include them.
Expect to pay between $5 and $35 per person, depending on the coverage and your age and location. Family plans usually offer slightly lower rates per person than individual plans, so individuals should expect to pay around $10 minimum for coverage. The higher your premium, the more your policy will cover.
Before buying a plan, check the insurance company’s website to verify your regular eye doctor and optical retailer are part of the network. A different insurance plan or a vision discount plan might work better if your providers aren’t part of the plan’s network because you won’t save as much, if anything, as you would if they were in-network providers.
Vision Insurance Pros & Cons
Vision insurance isn’t the right choice for everyone. Consider the pros and cons, then run the numbers to see if it adds up for you.
Vision insurance has a lot of benefits, especially since it’s so much simpler than health insurance. These advantages make it a no-brainer for those who need moderate to considerable vision care.
- Choice of Coverage Level. Most insurance companies offer several policies with a range of coverage levels if you buy an individual or family vision insurance plan directly. Ensure the policy focuses on what you plan to buy: glasses or contacts.
- No Deductible. Unlike health insurance, vision insurance doesn’t require you to meet an annual deductible before benefits begin. You just pay the copays and premiums, meaning you can take advantage of your benefits as soon as any waiting periods are over.
- Affordable Premiums. You can find vision insurance for between $5 and $35 per person. The per-person rate may be even cheaper for family plans.
- Easy to Buy. Some employers offer vision insurance, making it very convenient. Otherwise, you can check with your health insurer or a vision insurance company like VSP or EyeMed. Comparison sites like eHealth show you multiple insurance companies and help you compare benefits.
- Not Usually Tied to Employment. Most employers don’t offer vision insurance, and those that do don’t usually subsidize it. As such, even if your employer does offer it, you should shop around. The company they chose may not have the best rates or coverage for you. Plus, it’s easy to replace if you leave your job.
Vision insurance is not comprehensive like health insurance, so know its limitations before buying.
- Limited Provider Network. Your favorite optometrist and optical store may not be part of the insurance network. Vision insurance may not be worth it if you use an out-of-network provider.
- Limited Coverage. Vision insurance covers eye exams and corrective lenses once per year. Lower-premium plans may only cover eyeglass lenses but not the frames. Additionally, they have limited or no coverage for lens enhancements.
- No Coverage for Eye Illness. While an optometrist can diagnose eye illness, vision insurance doesn’t cover treatment for ongoing conditions like glaucoma or cataracts. Health insurance does.
- High-End Plans Are Probably Not Worth It. High-premium vision plans don’t necessarily provide superior benefits or value over lower-premium policies. They are still limited to exams and corrective lenses but have different copays. So your needs determine which is best for you.
- There May Be Waiting Periods. Depending on where you get your insurance, there may be a waiting period of at least 30 days and as long as 36 months, though many vision plan providers allow you to start using coverage immediately. If you need coverage immediately or soon, be careful which provider you choose.
Should You Get a Vision Insurance Plan?
Vision insurance makes sense for people like me, who need an exam every year and are likely to need a new prescription each time. But it may not be right for everyone.
First, consider how often you need an eye exam. If you or your family members see an optometrist every year and need new corrective lenses, vision insurance can help. I never had vision insurance because my eyesight was sharp until I turned 40. Since I’ll probably need a new prescription and glasses every year, buying vision insurance now makes sense.
Professionals recommend children under 6 months get regular vision checks. Since children primarily learn visually, doctors also recommend a vision exam before starting kindergarten or first grade. Adults under 40 can go for an eye exam every two or three years, while people 40 and up should go annually.
But if you or your child have existing vision issues, such as childhood high myopia, you may need checkups more regularly. Additionally, you should be aware of any symptoms of deteriorating vision so you can buy vision insurance before you find out the hard way you need it. If you’re over 40, it’s only a matter of time before you do. For more information on vision exam frequency and warning signs it may be time to get insurance, see the Atlantic Eye Institute’s guide.
Base your decision to get vision insurance in part on how often you anticipate needing exams. If your individual vision insurance costs you $300 per year and you only need checkups every couple of years, even if they cost $200, you’re better off putting away $10 per month to pay for it out of pocket. So do the math.
If you opt for insurance, ensure your preferred optometrist and optical retailer are part of the network before signing up. If they are out of network, that vision insurance doesn’t make sense because you end up paying an insurance premium for coverage you can’t use. If you’re committed to staying with certain providers, ask what insurance they take and get a policy with one of those companies or look for vision discount plans like Careington or DentalPlans.com.
Third, review your past costs for eye exams and corrective lenses. Compare it with the vision insurance policies you are considering. Add the exam, lens, and premium costs against your previous out-of-pocket costs to determine if you come out ahead.
Finally, vision care is an eligible expense if you have a flexible spending account (FSA) or health savings account (HSA). You can use your FSA with vision insurance to pay copays and additional fees. Or skip vision insurance entirely and pay the bills with your FSA or HSA balance.
Families with several members needing glasses and eye exams regularly or people over 40 will benefit the most from vision insurance. Young, single, childless individuals are least likely to need it.
If vision insurance isn’t worth it or you don’t have it when you need it, there are other ways to save on glasses and contacts, like changing providers and using coupons.
If you have an eye illness like glaucoma, retinopathy, or cataracts, you need health insurance, not vision insurance. Vision insurance may not cover the necessary enhancements to correct vision properly if you have a strong prescription or seek treatment more frequently than yearly.
Vision Insurance FAQs
Fortunately, vision insurance is far less complex than health insurance. But you may still have some of these common questions.
How Much Does Vision Insurance Cost?
Insurance typically costs between $5 and $35 per person. Family plans have cheaper per-person prices, so you may not be able to find one for less than $10 as an individual. If your employer offsets the cost of vision insurance, your monthly premium would be less.
Vision insurance premiums depend on several factors: your location, age, the level of coverage, and the insurance company.
Affordable Care Act-compliant health insurance plans automatically cover vision exams for children under 19 years old. So if you’re shopping for family vision insurance but your kids are already covered under their health insurance, you only need to buy a separate vision plan for yourself if you need it.
Is Vision Insurance Separate From Health Insurance?
Health insurance includes physician appointments, diagnostics, and treatment for medical conditions of the eye. They also cover infections, glaucoma, diabetic retinopathy, and macular degeneration. However, health insurance doesn’t cover routine vision exams or corrective lenses.
Vision insurance has separate copays, benefits, and usage rules. Also, a company other than your health insurer may issue the policy.
If you visit an optometrist yearly for eye exams and contacts or glasses, neither health insurance nor Medicare covers these. However, some Medicare Advantage (Part C) programs cover routine eye care because private insurance companies, not the federal government, manage the plans. Check your policy for details.
Where Can I Get Vision Insurance?
If your employer provides group vision insurance plans, you enroll the same way as health insurance. These plans may or may not be cheaper than plans you can get on your own. Your HR department can give you more information. Once you know the cost, you can check with vision insurance companies directly to determine whether your employer’s plan is a good deal.
However, if you’re not eligible for a group plan, you can buy an individual or policy through your insurance agent or directly from an insurer like VSP, Davis, EyeMed, Humana, or Ameritas.
Can You Get Vision Insurance if Your Employer Doesn’t Offer It?
Getting vision insurance is straightforward, even if your employer doesn’t offer it. There are several ways to find it:
- Contact your local health insurance agent. Many health insurance companies also have vision insurance plans.
- Buy directly through a vision insurance company.
- Compare policies at an insurance comparison site like eHealth or DirectBenefits.
Comparison sites have the most options and are the most convenient. You can compare policy benefits and prices from several companies. However, a single comparison site may not feature all potential insurance products, so check more than one.
Do Vision Insurance Plans Have Waiting Periods?
Sometimes. While many vision plans’ benefits kick in immediately, you may have a waiting period of 30 days to as long as 36 months (three years). As such, you should always check the waiting period for the insurance you’re interested in to ensure it kicks in by the time you need benefits.
What’s the Difference Between Vision Insurance and a Vision Discount Plan?
Vision insurance pays for eye doctor visits and corrective lenses annually. Depending on your plan, the insurance pays the provider directly, or you submit a reimbursement form.
Vision discount plans don’t pay the provider at all. Instead, you pay an annual membership fee to join the discount plan. And if the provider (eye doctor or optical retailer) participates in the program, you pay a lower rate the discount plan company negotiated.
You can join a vision discount group individually, as a family, or through employer or employee associations. Vision discount plans have no usage limit or prior approval, and you can combine them with insurance.
When shopping for vision coverage, take time to run the numbers because it could save you hundreds per year. Lower-premium and mid-premium plans are most likely to provide value if they’re under $15 per month. High-premium plans probably aren’t worth it for most people because the premiums are high for the amount of coverage you get.
Contact your optical retailer if you’re unsure whether vision insurance can save you money. Licensed opticians can provide insight into whether insurance is worthwhile for your needs. Also, each time you get glasses, ask for an itemized receipt of your lens features so you can perform a side-by-side comparison between self-pay and insurance.