Read the Fine Print: What Does Vision Insurance Cover?

by Team eLocal
Myopia Concept. Elderly woman squinting while looking at smartphone screen, trying to read message, closeup

Your eye doctor can help you see clearly, but having a clear understanding of how your vision insurance works isn't always as easy.

It's a good idea for everyone to see the eye doctor occasionally, even if you have perfect vision. Using insurance for the visit can help you save money, especially if you need glasses or contacts.

What Is Vision Insurance and How Is It Different From Medical Coverage?

Vision insurance is a separate policy that only provides coverage for vision care. Regular medical insurance provides coverage for lots of different healthcare services, including preventative care, illnesses, injuries, surgeries and hospitalizations.

Some regular health insurance policies include vision coverage. Marketplace health insurance policies have to provide vision coverage for children. While they don't have to provide vision benefits for adults, some plans do offer it. If your health insurance doesn't have any vision coverage, you can purchase a separate vision insurance policy.

What Does Vision Insurance Typically Cover?

Vision insurance coverage can vary by policy, so it's important to compare several policies and review what they cover before you choose one. Some policies only cover certain parts of vision care, such as exams, while others cover multiple things. Common things that vision insurance might cover include:

  • Regular eye exams
  • Prescription glasses, including frames and lenses
  • Contact lenses
  • Discounts on LASIK surgery

Most vision insurance plans only cover a portion of the costs for these things. For the eye exam portion, it's common to have a copay. For glasses and contacts, you might receive up to a certain dollar amount toward them, or you might get a percentage discount off the total price.

What Doesn't It Cover?

Some vision plans don't cover certain types of corrective lenses. For example, your plan might only cover basic lenses and not thinner, lightweight lenses or extra coatings, so if you want those extras, you'll have to pay for them out of pocket. Plans that pay for contact lenses might only pay for certain brands.

If you need surgery or treatment for some eye conditions, the procedures often fall under your regular health insurance, rather than your vision insurance. Even if your health insurance doesn't have vision coverage, it typically covers major health issues related to your eyes, such as injuries and illnesses. If you're diagnosed with an eye disease or medical issue, your eye doctor and the insurance companies can help you decide which insurance will cover the treatment.

You might also find that your vision insurance doesn't cover some eye care providers. Like regular insurance, vision insurance sometimes requires you to go to one of their in-network providers to receive your benefits. If you go somewhere else, the plan might not cover the expenses.

Other things your vision insurance might not cover include:

  • More than one annual eye exam
  • Charges for missed appointments or other extra fees
  • Nonprescription glasses
  • Replacing glasses that are damaged or lost

Read the fine print to find out about these and other limitations or restrictions.

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Is Vision Insurance Worth It?

Whether vision insurance is worth your cost depends on your situation. If you get vision coverage included in your regular health insurance plan, you're not paying any extra, so it's worth using. You'll likely save at least some money with it.

If you're thinking about buying a separate vision insurance plan, get several quotes for policies, and total up how much you'll pay over the year. Then, calculate the estimated amount you'll spend on eye exams, contact lenses and prescription eyeglasses. Using the coverage details for the policy you're considering, calculate how much you'll save. If you would save more than you'd pay in premiums, you might want to consider buying the coverage.

People who get yearly exams with contacts or who buy at least one new pair of glasses each year are more likely to save enough money to make vision insurance worth it. If you don't have any vision issues, it might be cheaper to pay for your exams out of pocket.

How Do You Buy Vision Insurance?

If your health insurance doesn't offer any vision coverage, you'll have to buy a vision plan from a private insurance company. Standalone vision plans aren't available through the marketplace insurance program. Some employers offer a separate optional vision plan that you can purchase through them. Check with your HR department to see if your company offers it. If that's not an option, you can contact a local insurance agent or look for vision insurance quotes online.


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