Healthcare coverage in the Garden State can be a confusing topic. New Jersey recently passed legislation that makes minimum essential health coverage mandatory for state residents, but this still leaves many of the
Here’s how to choose the best vision insurance provider in New Jersey.
The Best Vision Insurance in NJ:
- Best Overall in NJ: VSP Vision – See $13 Plans
- Best Customer Service: Davis Vision
- Best for Low Deductibles: Horizon Blue
- Best for Seniors in New Jersey: Humana
An Overview of Vision Coverage in New Jersey
The federal healthcare mandate is gone for now but some states are rolling out state-level health insurance mandates that require residents to have coverage for essential care. New Jersey is among a handful of locations where you’ll need basic coverage.
Basic coverage, which parallels the 10 Essential Health Benefits requirements of the Affordable Care Act, includes vision coverage for children but does not include coverage for adults. This leaves many New Jersey families uninsured or partially insured for vision care. Many health insurance plans don’t provide vision insurance.
Another concern is for New Jersey seniors who make up nearly 15% of the state’s population. Without a Medicare Advantage Plan or a Medicare supplement, Medicare doesn’t cover routine vision exams or pay for essentials like glasses or contacts.
Those who qualify for Medicaid have coverage for vision care, including periodic exams, new frames and prescription lenses. However, expect coverage to be limited. For example, adults have coverage for a new lens prescription once every 2 years and there is no coverage for contact exams, contact lenses or many lens treatments like no-line bifocals.
Seniors not covered by a 3rd-party plan or families who don’t have full coverage for vision care through their health insurance provider can choose from several providers who specialize in vision care insurance.
Often, specialized vision insurance providers provide more comprehensive coverage than coverage bundled with health insurance plans and can eliminate concerns over costly deductibles.
Many leading vision insurance providers don’t use a deductible at all and instead use affordable copayments for some services.
What to Look for in the Best Vision Insurance Companies
Most vision insurance coverage isn’t really insurance, but today’s vision plans act much like insurance because they reduce the risk of large out-of-pocket expenses. The average annual cost of wearing glasses can be hundreds of dollars per year and the cost of wearing contacts can reach even higher.
Modern vision plans use a monthly premium or fee to help keep costs predictable and affordable and often cover the cost of annual exams, lenses and frames and only require a small copayment.
Expect to find good, better and best options with most New Jersey vision insurance providers. You may exchange higher monthly costs for more comprehensive coverage as you move up in plan level.
This structure allows you to find a plan to fit your budget and gives you the freedom to choose the level of coverage you need rather than forcing you into a more expensive plan.
Costs can range from under $10 per month up to $30 per month or more but you might want to choose a mid-level plan that offers generous coverage that won’t break the bank. Plan pricing becomes more affordable per person on family plans.
You’ll find similarities among vision insurance options in New Jersey and not all plans are created equal. Evaluate your options based on the size of your household and the vision care you expect to need for each family member.
Here are some of the key features you may need for your family’s vision care.
Affordable Annual Exam Coverage
You might find eye exams as low as $50, but the average cost is often closer to $100. You may be able to save hundreds on the cost of exams alone if you choose the right plan. VSP, a leader in vision plans, offers annual exams for a low $15 copay on some of its plans in New Jersey.
Exam copays with other providers range from $10 to $40. A handful of plans do not cover annual exams.
Ample Frame Allowance
Glasses are often less expensive than contact lenses. Frames can range from inexpensive options to fashion brands that can cost hundreds. Don’t expect your vision insurance to cover the most expensive frames but, as a minimum, you’ll probably want coverage that gives you an allowance of $100 to $150 or more toward frames.
An allowance refers to how much the vision plan will pay toward your frames. Amounts above the allowance may be given a discount or may not be covered at all.
Pay careful attention to how often you can replace frames and lenses when you choose a plan. Some plans only offer frame replacement once every 2 years. Eyesight can change rapidly. A plan that offers frame replacement once per year is often a better fit.
Lenses usually use a copayment as your share of the cost, which means the plan picks up most of the cost of lenses and you pay a small payment toward your new lenses. Lens copayments tend to range from $20 to $25 for single vision, bifocal, or trifocal lenses, but some plans may make a distinction and charge a higher copayment for bifocals or trifocals.
As with frames, how often you replace the lenses is important. Some plans offer a replacement once every 2 years. Plans with annual lens coverage provide better financial protection.
Progressive, scratch-resistant or tinted lenses may cost more. Many plans use copayments for lens options and the potential out-of-pocket costs can be high depending on the options you want.
VSP offers a plan in New Jersey that includes progressive lenses or light-to-dark tinting with no copay. If you use either of these common options, VSP’s EasyOption plan may be a good fit.
Preferred provider organizations are common for vision insurance providers, which makes network coverage a strong consideration. You’ll want to use in-network providers to get the most from your plan. Check for local eye doctors in the plan and if you have a preferred doctor, check to see if your doctor is in the provider’s network.
Out-of-network services may not be covered or covered for a lower amount. Both situations can increase out-of-pocket costs.
Annual commitments are common among New Jersey vision insurance providers and help to keep premiums affordable. Expect to pay for coverage for a full year when you choose a provider. In nearly all cases, however, you can pay for your vision insurance with smaller monthly premiums. Some providers may offer a discount for paying for a full year in 1 payment.
Our Top Picks for the Best Vision Insurance in NJ
New Jersey offers several choices for vision insurance. The company that’s the best fit for you depends on family size, budget and the services you’ll need.
1. Best Overall: VSP
It’s clear that VSP finds a balance between affordability and value with a customer satisfaction rating of 92% among VSP members. There are cheaper plans available than VSP, but possibly at a cost that won’t be obvious until you need vision care.
VSP offers 3 plans in New Jersey aimed at annual vision care and a 4th plan that offers new glasses every other year but which has a lower monthly cost.
Most households will find the most value in VSP’s Standard plan or EasyOption plan. VSP’s Standard plan costs about $15 per month for an individual and provides annual eye exams with a low $15 copayment. The frame or contact lens allowance on the Standard plan is $150 and the copayment for basic lenses, including bifocals and trifocals, is only $25.
VSP is the largest vision benefits company in the U.S. and has established a massive doctor network to service its 82 million members nationwide.
2. Davis Vision
Known for its coverage at many top eyewear retailers, Davis Vision’s network is expansive and includes over 93,000 service providers throughout its coverage areas.
Davis offers several plans in the Garden State but most households will find value Davis’ Classic or Premier vision plans, both under $14 per month for individual coverage. These plans offer a $130 frame allowance and a lens copay up to $25. Eye exams and frames/lenses or contact lenses are covered annually with only 1 copayment.
With some plans, like Davis’ Premier plan, many lens treatments that are extras with others can be included at no charge. Copays for other lens options vary, but are priced lower than some competitors.
Humana is a popular choice for vision care in New Jersey and you have the option of bundling Humana dental insurance coverage as well, another health and wellness area not covered by some health insurance plans. Humana’s Vision Focus plan offers annual eye exams with a $10 copayment.
Standards contact lens fittings are $40. Frame allowance is capped at $100 for in-network providers with amounts above $100 covered by a 20% discount.
Humana’s frame allowance applies once every 2 years, while lens replacement is available annually. If you use lens options, take a closer look at Humana, which offers several popular options for as low as $15 copayment each.
4. Horizon Blue
Part of the nationwide Blue Cross Blue Shield network, Horizon offers 2 plans at under $14 per month for individual members. Family plans are also available and can add to your savings. Both plans offer annual exams with a low $10 copay, and frame and lens benefits are available once every year.
Frame allowance for other in-network providers is reduced to $100 for Horizon Vista V, the less expensive plan and $130 for Horizon Panorama V, Horizon Blue’s step-level offering. There is no copayment on either plan for plastic lenses, whether single-vision, lined bifocal, trifocal or lenticular lenses — and a 1-year eyeglass breakage warranty is included.
Choosing Vision Insurance in New Jersey
The cheapest coverage isn’t always the best choice. We found options as low as $5 per month but price-leader plans may not provide enough value and don’t always accomplish the goal of making vision care costs affordable and predictable. It’s easy to underspend or overspend on supplemental coverage like vision insurance.
Often, the best value is somewhere in the middle, but it’s important to check the details of each plan to be sure it meets your needs. A vision insurance plan that focuses on annual exams and annual coverage for new frames and lenses provides better protection.
Frequently Asked Questions
1) Q: How do I ensure that I’m properly covered?
Speak with an agent or your carrier directly to determine if you have appropriate coverage to meet your needs. Vision insurance can be customized; if you want more or less coverage you can do so by altering your policy.
2) Q: What’s typically included with vision insurance?
Eye exams and prescription lenses are typically included with your vision coverage. Some companies pay for all of the costs and other times there will be a co-payment required for the services received or the lenses that you choose.
3) Q: What types of vision plans are available to me?
Generally, there are just two types of vision plans: benefit plans and discount plans. They usually cover the same types of exams and products but there will be a difference in monthly premiums. You can expect to pay much lower for the discount vision plan.