Just because you have a health Insurance plan does not mean you have coverage for eye exams and prescription glasses. This lack of coverage would primarily depend on two factors:
- Where your insurance is coming from.
- The age of the individual to be covered.
An Affordable Care Act (ACA) mandate requires that if you receive your insurance through the marketplace, your children up to the age of 19 are covered for vision benefits. This mandate does not apply to adults.
If you have an individual health policy or obtain your health insurance through your employer, then you are not covered for routine eye exams or glasses. The policies offered through your employer only cover vision problems if they are part of a covered injury. One would have to purchase a stand-alone policy to cover vision benefits.
These policies are relatively inexpensive, and most have excellent coverage, even for a large family.
What is vision insurance?
Your primary health insurance plan would cover you if you were to have an injury to your eye due to an accident. Vision insurance is different. It is used for visiting an optometrist or ophthalmologist for routine eye care. Vision insurance also covers vision repair surgery, (such as LASIK that would not be covered under a traditional health insurance policy.
Without vision insurance, you can expect a routine eye exam to cost you anywhere from $50 to $250. Your cost would depend on:If you visit an optometrist or ophthalmologist.
- If you visit a chain vision center or an independent doctor.
- Other tests that are needed in addition to a routine exam.
- If you choose contacts, the exam and cost differ from a routine exam.
Keep in mind that the rate is only for the exam. Frames and lenses can run into the hundreds of dollars. The national average is around $150 for frames and $90 for single vision lenses. That does not include extras like progressive lenses, anti-reflective coating, or polycarbonate lenses to make the lenses lighter.
Not having vision insurance can be costly. Even if only two members of your family need glasses, that could easily cost you what would amount to your mortgage payment. This is why having vision insurance coverage is crucial to help mitigate the expense when multiple family members need vision correction.
Average cost of vision insurance
Vision insurance is like health insurance in that when you purchase a policy, it is based on an annual premium that can be broken down into monthly payments. These rates can vary depending on certain factors:
- Where you purchased it. Buying your policy through your employer, the marketplace, or on the individual market will determine your premium.
- Where you live. Just like health and auto insurance, premium amounts vary from state to state and company by company.
- If your children are students. Some companies require children 18 to 25 to be enrolled full-time in college to be covered under a parent’s policy.
For an individual
Vision insurance can cost as little as $5 a month. Most hover around the $10-$15 per month, which can amount to $60-$180 per year. The yearly premium is less than what it would cost to have an eye exam and purchase glasses without insurance. There are options to have additional coverages for an increased premium; well get more into that later when we discuss coverages.
For a family
Once you reach family status, the premium in some cases will not increase. This means that once you have three kids, the fourth one generally will not affect your premium. A family of four can expect to pay about $40 to $80 per month, depending on the level of coverage selected. This amount is still less expensive than having to pay for only two members of the family that would need corrective lenses.
What does vision insurance cover?
Insurance companies that sell vision insurance typically have different levels of coverage, usually with names such as standard, basic, enhanced, and advanced. They will differ in the premium amount that will reflect the type or amount of coverage available with the plan. As a rule, vision insurance has some level of coverage for the following:
- Eye exam: The insured is entitled to one vision exam per year. You will pay a co-pay of $10-$20 for most insurers
- Eyeglass frames: This benefit usually comes as an allowance. Depending on the coverage level, you can receive a $120 allowance up to $220. This benefit is also once per year.
- Eyeglass lenses: Lenses will be benefited as a copay. Most are around the $20-$30 amount, also per year.
- Contact lenses: For contacts, you could see either a copay or as an allowance.
- LASIK surgery: Most insurers offer a discount on a type of vision corrective surgery. The discount amount varies from company to company but is generally about $500.
Other enhancements are offered at a discounted rate. These can include:
- Scratch-resistant coating
- Anti-glare coating
- Polycarbonate lenses for stronger, thinner lenses
- Transition lenses, which turn into sunglasses when exposed to daylight
- Progressive lenses, which are no line bifocals
What does vision insurance cover?
Just like any insurance policy, there are certain things that vision insurance will not cover. This also varies by company. Be sure to ask about limitations and exclusions when you purchase a policy. Some of the common exclusions are:
- Additional exams beyond the one per year.
- Replacement of damaged or lost glasses unless appropriate warranty insurance is purchased.
- Missed appointment charges, application fees, or other miscellaneous charges.
- Non-prescription glasses, like magnification reading glasses.
- Any treatment to the eye that is medical in nature. These injuries, surgeries, and treatments should be covered under the insured’s health insurance policy.
- Experimental or investigative procedures.
- Treatment where the doctor is a member of the insured’s family.
What are my best options?
Check their websites for rates and availability. To assist you, we have chosen three highly rated companies that provide vision insurance for you and your family. These choices will be from the open market.
Note: If you have children under the age of 19 and you currently have health insurance through the marketplace, they will already have coverage for vision. This a mandate under the Affordable Care Act.
VSP is the largest vision insurance company in the United States. If you have vision insurance, chances are it is with VSP. VSP offers low copays, high allowances, and is widely accepted across the U.S. VSP has been awarded Best Vision Coverage by the Benefits Selling magazine Readers’ Choice Awards for the last eight years.
Depending on where you live, premiums for a standard individual policy can begin at a little over $15 per month. Family plans are just under $40 per month.
EyeMed received a four-circle per rating from J.D. Power based on overall customer satisfaction. Vision insurance through EyeMed is accepted at over 44,000 independent and retail providers. Most insurers offer a 20% discount on a second pair of glasses within the policy year; EyeMed offers a 40% discount. Committed to the community, EyeMed is also a proud supporter of OneSight, a nonprofit organization that provides vision care in underserved communities across the world.
EyeMed’s individual vision discount plan begins at $5 per month, and the family plan is more extensive, with allowances and copays. It starts around $30.
Davis Vision also received a four-circle rating for customer service from J.D, Power. Davis Vision also has over 70,000 nationwide points of access for customers. Nearly 9,000 offer the exclusive collection,a unique discount on an assortment of frames that are offered only to Davis Vision members. Davis Vision also provides a warranty on your plan-covered glasses for a year. Should you break them, simply return them to the vision center for replacement.
Premiums for an individual range from $10-$12, and for a family, it hovers around the $30 mark.
If your employer offers a health insurance plan, chances are they offer dental and vision insurance. This is by far the most affordable option for individuals as well as families. VSP with an employer can warrant a group discount, costing the employee about $20 a month for an entire family.
Some may feel that they see clearly and have no need for glasses, so they pass on vision insurance. However, an optometrist or ophthalmologist will help you determine your actual vision impairment through a comprehensive eye exam.