By Michael Bihari, MD. Health Insurance Expert
Updated June 16, 2014.
If you have an eye disease or eye injury your regular health insurance will pay for diagnosis and treatment. However, most regular health insurance policies do not pay for the costs of routine eye exams, corrective lenses, eyeglass frames, or contact lenses. Insurance coverage for such services is known as vision care insurance.
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According to the U.S. Department of Labor, less than 30% of employees receive vision care coverage.
What Does Vision Care Insurance Cover?
Vision care insurance usually pays for the following basic services:
- A yearly eye examination, including refraction to check your vision
- Eyeglass lenses
- Eyeglass frames
- Contact lenses
- LASIK and PRK vision correction procedures at a discounted rate
Your specific vision care plan may have a limit (such as every two years) on how often it will pay for lenses and frames.
Who Provides Vision Care Services?
Usually, vision care plans (including those you buy or are provided by your employer) contract with eye care professionals to provide you with vision care services. In some plans you can use any eye care provider and receive a discount on the services offered. However, most plans purchased from a vision care insurance company are PPOs (preferred provider organizations) in which your eye care is managed by a network of eye providers. In a PPO, you also can use out-of-network eye providers, but you will pay a greater share of the cost.
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Eye care network professionals typically include optometrists and general ophthalmologists. Some networks also may include ophthalmologists who perform refractive surgery and provide LASIK and other vision correction procedures.
An optometrist, also known as a doctor of optometry, is licensed to examine your eyes to diagnose vision problems, such as nearsightedness and farsightedness, and prescribe eyeglasses or contact lenses. Your optometrist also can test you for glaucoma and other eye diseases and diagnose eye problems related to diseases such as diabetes and high blood pressure. Optometrists can also diagnose and treat certain types of eye diseases, such as conjunctivitis
(pink eye). Ophthalmologists are medical doctors who perform eye surgery, diagnose and treat diseases and injuries of the eye. Ophthalmologists, like optometrists, can also examine your eyes for vision problems and prescribe eyeglasses and contact lenses.
Where Can I Buy Vision Care Insurance if I Can’t Get It From an Employer?
Similar to dental insurance, you may be able to purchase vision care coverage through a local business group, college alumni association, fraternal organization, or religious group. If you are over 65, you may have a vision care (including eyeglasses) benefit if you are part of a Medicare Advantage Plan.
You also can purchase your own vision benefit plan. For example, two of the larger eye insurance companies in the country that offer individual vision care policies are Vision Service Plan and Humana One. Both companies’ web sites provide access to information about the vision plans available in your state.
Should I Buy Vision Care Insurance?
If you wear corrective lenses and need periodic eye exams and changes in your eye lens prescription, it may be worthwhile to purchase vision care insurance. If you do not currently wear or need glasses, you may be able to get a periodic eye exam through your regular health insurance plan.
An individual plan may cost you from $150 to $180 per year depending on where you live. You may also have a copayment for the initial eye examination and for the corrective lens prescription. The typical benefit usually includes:
- Eye Exam - Covered in full
- Prescription Lenses - Covered in full
- Frames - Covered up to $120
- Contact Lenses - $120 allowance for the cost of your contacts and the contact lens exam
Another option is to enroll in a discount plan, which provides a specific discount for vision-related services. Although not an insurance policy, these plans can save you up to 30% to 40% off the retail price for exams and corrective lenses. For example, if you are a member of AARP. you can save 30% on eyeglasses and 20% on contact lenses by just presenting your AARP card to a participating vision care provider.