Yearly eye exams, eyewear, and vision treatments can become expensive fast. While we wish traditional health insurance could take care of everything, it only covers eye care to an extent.
To make up for it, insurance companies sell this specialized plan for all of your eye care and eyewear needs. Read on to find answers to the most commonly asked questions regarding vision insurance and its coverage.
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Health Insurance Vs Vision Insurance: What’s the Difference?
An easy way to break down the differences between what falls under “medical” and “vision” depends on the reason for your visit. Routine eye exams focus primarily on your vision, whereas a medical eye exam screens, diagnoses, and treats eye conditions.
Let’s use an example. If the reason for your visit is to have your eyes checked, but you’re diagnosed with glaucoma, the visit still falls under routine eye exam. Here’s what happens next: the portion of your visit related to eye health will be charged a refraction fee. Medical insurance will only cover the health aspect of the visit.
What Does Vision Insurance Cover?
Now that you know what vision insurance plans entail. Let’s look at what it covers. Here’s a comprehensive list of what services, exams, and products are included.
- Annual eye examinations
- Prescription eyewear such as eyeglass lenses, frames, or contact lenses
- Lens protection for glasses (coating, enhancements, etc.)
- Discounts on corrective eye surgery (Lasik and PRK)
Types of Vision Insurance
Normally, you would obtain coverage from pre-existing insurance as part of a network (HMO, PPO, etc.) or program. However, if you have to purchase the plan individually, here are your options.
Vision Benefits Package offers free eye care services and eyewear. In return, you pay a fixed annual and a small copay each time you use a service. Policyholders who expect to make frequent visits and want fixed prices will often take this route.
Discount Vision Plan offers services at a discounted rate after you pay your annual premium. In both instances, you also have to pay a deductible in full before you can start receiving coverage.
Who Needs Vision Insurance?
Children are the first candidates for yearly eye exams and early detection, but it’s recommended for everyone to get checked periodically. As you age, eye exams can reveal much more than declining eyesight – it can detect hidden medical issues. You should enroll for this stand-alone plan if:
- You’re 55 years old or over
- You need more coverage than routine exams
- You have poor eyesight and need eyewear
- You or your family have a history of eye disease or conditions that increase the risk of eye disease (diabetes, hypertension, etc.)
Vision Insurance Costs
How much can you save on a stand-alone vision plan? Well, that will depend on the program you choose. On average, whether you receive coverage from a stand-alone plan or through an employer, your premiums can be $5 and $15 a month. For every dependent added to the plan, theirs may be lower. There’s also a one-time enrollment fee when you sign up.
Depending on your level of coverage, services will be benefited by a fixed copay rate or allowances. For expensive procedures such as enhancements and corrective surgery, you’ll receive a significant discount off the total amount.
Where to Find Vision Insurance
Are you not sure where to start? These are some of the common ways to enroll you and your family for coverage through:
- Group coverage (school district or an employer)
- Programs such as Medicare or Medicaid
- Indemnity health insurance (HMO or PPO network)
Vision Insurance: Is it Worth It?
How important vision coverage is will depend on a case-by-case basis. Are you healthy and only need yearly routine exams? It’s very possible that you don’t need the extra coverage. On the other hand, if you need additional tests, treatments, or help with corrective eyewear, it’ll make those services more affordable for you.
Bottom Line
Any kind of healthcare plan can be confusing at first – but it doesn’t have to be. Consult with your primary care physician about any concerns you may have. Take into consideration your age, risk factor, and medical history to determine what kind of plan would work best for you.