Getting a comprehensive eye exam, prescriptions, new lenses and frames could mean a hefty price sticker. Health insurance policies typically cover eye care only if you have a medical issue. You may, however, lower the costs by signing up for vision plans — through your employer or buying a plan on your own. But what types of vision insurance are there?
If you’re buying coverage, it helps to know the types of vision insurance, any special laws, average costs and which plans are most affordable.
Types of Vision Insurance
Vision insurance plans are available as either add-on (optional riders) to your primary health insurance plan or through an ancillary plan (stand-alone plan) that provides benefits not available through major health plans, like vision and dental insurance.
The way your insurance coverage works depends on the kind of insurance it is classified as. Here are the types of vision insurance plans.
Preferred Provider Organization (PPO) Plan
This plan provides coverage to participants through a network of select health care providers, like physicians and hospitals. You may use out-of-network specialists but will incur more costs in the form of higher coinsurance rates, higher deductibles or nondiscounted charges from the providers.
Health Maintenance Organization (HMO) Plan
This plan limits coverage to care from doctors who contract with or work for the HMO. This plan doesn’t cover out-of-network care unless in an emergency. An HMO may require you to work or live in its service area to qualify for coverage.
Point of Service (POS) Plan
This plan lets you pay less if you use hospitals, doctors and other health care providers who belong to the plan’s network. You must get a referral from your primary care doctor to see a specialist.
Indemnity Insurance Plan
This plan lets you choose a provider without any effect on reimbursement. Your insurance carrier pays for some or all of your vision care.
An Overview of Vision Insurance
Vision insurance — a type of supplemental health plan — may help offset expenses related to eye care, such as vision corrective wear, annual eye examinations, corrective eye surgery, contact lens exams and more.
The Affordable Care Act (ACA) guidelines stipulate that vision care is an essential benefit for children under age 19 — all plans sold in the Health Insurance Marketplace should include vision care for children. Only a few plans include vision coverage for adults. If your plan doesn’t include vision coverage for adults, you could enroll in an individual vision plan.
The Health Insurance Marketplace does not offer stand-alone plans. Contact an insurance broker or search for plans online here.
The cost of vision insurance depends on various factors, but monthly premiums can range from $10-$30 per person. Policies that charge higher monthly premiums come with reduced costs for care. The catch is that all policies have some coinsurance costs, copays and limits on coverage.
Without a vision insurance plan, you will pay about $152 for a routine eye exam and over $200 for eyeglasses. Most plans need a 12-month commitment — it keeps premiums affordable for all subscribers.
Vision insurance doesn’t use the deductible available with traditional health insurance plans but borrows the idea of copayments. Smaller copays are needed for services like lenses, lens treatments or eye exams. Contact lenses or frames are covered in the form of an allowance that’s a fixed amount you may spend in your plan.
Your policy may not cover elective corrective surgery, like PRK or LASIK but some plans offer a significant discount on these services.
So, what should you look for with vision insurance?
- Annual benefits: Ensure your vision plan covers all yearly benefits. For instance, some plans will offer 1 eye exam and glasses every 2 years while others offer an exam annually and frames every 2 years. Plan prices may be unusually low, so check carefully.
- Doctor network: Look for a provider with a large network of independent doctors. Be on the lookout for carriers that promote large numbers by highlighting access points instead of locations.
- Frame allowance: Your vision plan should provide a generous allowance for frames. Other plans offer a higher allowance for specific frame brands and reduced coverage for frames outside these brands.
- Lens enhancements: Make sure you’re covered if you wear progressive lenses.
- Enrollment fees: Beware of hidden fees in vision coverage. Many plans disguise a high enrollment fee with a lower monthly fee when signing up — making the plan more expensive.
Average Cost of Vision Insurance
You can expect to pay $10–$30 per month for vision insurance, depending on the plan you choose and the rates in your state. Prices could also go above $40 if you pick a plan with a larger network of doctors. At the bare minimum, your vision plan should cover an annual comprehensive eye exam, contacts or frames and lens enhancements. Other aspects to consider are your overall frame allowance and how often you need new glasses.
Some plans advertise low rates but offer an overall low frame allowance or fail to provide savings on lens enhancements. You’ll also want to ensure the doctor network also includes convenient locations. Read the plan fine print to make sure you’re getting a bargain to match your needs.
Here’s how much you could be saving by buying a vision plan in various parts of the country.
|State||Average cost of an eye exam||Estimated annual out-of-pocket cost with vision insurance||Estimated yearly out-of-pocket cost without insurance|
When is Vision Insurance Worth it?
You may wonder if a vision insurance plan is really important if you’re using Medicare or a stand-alone health insurance plan. However, coverage for corrective lenses and eye exams is excluded in most health insurance plans. Under the ACA, vision and dental benefits are only needed for children on each plan — adults will cover 100% of these expenses on their own.
Vision insurance may be worth it when:
- You need to cover a family.
- You have Medicare, which typically doesn’t cover routine eye exams, glasses or contacts.
- You don’t have much money saved.
Compare Vision Insurance
How do you pick the best vision insurance provider? Start by asking family and friends who may need an exam in the next 12 months. Go through insurer websites for average rates, availability and available plans — from basic to premium plans.
VSP® Individual Vision Plans can provide vision coverage to anyone, from self-employed to retired. The provider allows you to enroll in a vision plan by phone or online 24/7 from your home. There are multiple plans to choose from, with the most affordable plans starting as low as $13 per month.
Once you enroll in a plan, VSP lets you choose between paying your annual premium all at once or in monthly installments. Individual vision plans cover you for 12 months, within which you can schedule an appointment and take advantage of benefits. Individual vision plans have no enrollment fees and you choose a billing date.
You can expect to save more than $200 per year with every vision plan you buy, and the monthly payment options help you manage your budget.
UnitedHealthcare offers what most vision insurance plans don’t — double allowance per 12-month period for frames and contacts. Its expansive national network lets you pick from more than 80,000 providers, including retail chain and private practice locations.
The carrier also covers select contact lens purchases in full, including an initial fitting assessment and up to 2 follow-up visits. Generous allowances also apply to frames bought at the carrier’s network of providers. Lenses have a $10 copay — one of the lowest — and include standard scratch-resistant coating. However, you might pay more if you need additional lens enhancement options. There are no waiting periods and you’ll enjoy your benefits as soon as you enroll.
Set Your Sights on Eye Health
Your eyes are one of your greatest assets — without them, your world would be a different place. Caring for your eyes is more important than keeping your sight, and vision insurance can help offset the costs of eye exams, glasses and contact lenses.
The first step in figuring out whether you require vision insurance is identifying your vision care needs. Look at your existing coverage — you might already have vision insurance without realizing it. Finally, compare prices to see how much you are saving in out-of-pocket expenses.