Vision Insurance Overview
Vision insurance may seem like a thing you can go without if you are not squinting to see near or far. But according to the Vision Council of America, nearly 75% of adults rely on some kind of vision corrective device, whether it be glasses, contacts or both. In most cases, vision insurance can help keep money in your pocket by reducing the amount you pay for optometrist’s exams, vision testing, glasses and contacts. Vision insurance is helpful when it comes to cutting costs and it ensures you receive quality eye care when you need it.
What is Vision Insurance?
Just like other kinds of medical or dental insurance, vision insurance assists with the cost of seeing an eye doctor, along with the amount you pay for glasses, contacts and other eye-related services and needs. Vision insurance is generally supplemental to other kinds of insurance you may receive through an employer or union, meaning you can choose to opt-in to this kind of coverage. In many cases, general medical insurance does not cover visits to the optometrist or any non-emergency eye devices or care you may need.
You do not need to have a pre-existing eye condition to purchase vision insurance. In fact, this kind of vision coverage is beneficial for people who see just fine without contacts or glasses because annual eye appointments can detect changes in eyesight. Even further, regular eye exams are a tool used to detect the onset of other ailments such as diabetes, high blood pressure or high cholesterol.
How Vision Insurance Plans Generally Work
Vision plans, like other forms of insurance, generally come with a monthly premium. This amount varies by insurance provider, the kind of benefits you select and additional factors such marital status or being a smoker. After paying your monthly premium, you will have access to visiting an optometrist for your eye health needs.
In many cases, insurance providers may limit the number of annual exams you can have in one year, which greatly depends on your policy benefits. In addition, you may pay a copayment at the optometrist’s office during your visit. Depending on how much coverage your vision insurance provides for wearables such as glasses or contacts, you may pay no or some additional cost for frames, lenses and contacts you need to see clearly. In most cases, color contacts, eyeglasses or sunglasses needed for cosmetic reasons instead of medical reasons are generally not covered by insurance.
As with many kinds of insurance, your eye doctor will bill your insurance company after your visit to receive payment. At this point, the insurance company will apply your benefits and if any cost remains, you will be responsible for the balance. For this reason, it is a good idea to fully understand your benefits before stepping into the optometrist’s office.
For larger eye care needs, such as surgery, your insurance provider may require prior approval before the procedure. This allows the insurance company to anticipate the cost, relay to you the expected out-of-pocket contribution and ensure you are being treated by an appropriate eye care physician.
How the Affordable Care Act Impacts Vision Insurance
The Affordable Care Act does have some impact on vision insurance despite the fact that it is often an elective, opt-in form of health coverage. The biggest change is with vision care benefits for children; according to Affordable Care Act regulations, vision care is considered an “essential benefit” for children, meaning that any healthcare plan sold in the insurance marketplace must provide eye care benefits for children through age 18. For families with children that do not want to opt-in to vision insurance, this means that children still have access to annual eye exams as well as glasses. But, this rule only applies to healthcare plans covering children. For adults, there is no mandated coverage, meaning that a vision insurance plan is recommended for anyone over 18 who needs annual exams, glasses or contacts.
What Vision Insurance May or May Not Cover
Most vision insurance plans cover services such as annual eye examinations, including many of the tests done at these exams. In addition, if your doctor determines you need glasses or contacts, insurance may cover a portion or all of the cost of these items; in many cases, insurance providers will provide an allowance (dollar amount) for the eyewear you need such as frames and lenses, or limit you to a particular selection of frames. If you use both glasses and contacts, your insurance plan may only cover one or the other; in these situations, it is often smart to use your allowance on the more expensive of the two, saving the least expensive need for your out-of-pocket cost.
When it comes to additional specialty testing such as glaucoma testing, your insurance plan may cover a portion or all of the cost. In situations where you require specialty examinations or testing, reviewing your insurance benefits is the best guide to determining how much coverage you will receive and how much of the cost you will be responsible for.
Vision insurance differs drastically based on major eye surgeries or procedures. Just like other kinds of healthcare benefits, most vision insurers provide some kind of coverage for medically necessary procedures such as cataract surgery, which costs an average $3,500 per eye. But, other surgeries that are not deemed medically necessary, such as LASIK eye surgery, may be covered minimally or not at all.
Enrolling in a Vision Insurance Plan
There are a variety of options when it comes to enrolling in a vision insurance plan. Many people have the option of signing up for a vision plan through their employer or union, though vision benefits here are considered elective, meaning they are not part of medical insurance and have a separate premium. If you do not have vision insurance provided through an employer or union, a private policy is often your best option, especially since most Medicare plans don’t include this type of coverage either. There are hundreds of plans available offered by countless insurance providers. Instead of being bogged down with the search for a vision insurance plan, let PolicyZip’s insurance specialists help you narrow down the best options by calling (844) 205-7510 or filling out the form below.