Whether you want to ensure that your vision is in top shape or you’re offered a vision plan by your employer, you may be considering signing up for vision insurance. However, if you’ve never had a vision plan, the first question that probably comes to your mind is, “How does vision insurance work?”
Vision insurance is more simple than a regular health insurance plan and helps you cover the cost of vision expenses for you and your family.
Vision plans typically cover:
An annual eye exam
New glasses lenses
New frames or contacts
Keep reading for a simple overview of how vision insurance works and answers to common questions people have when deciding if a vision plan is worth it.
Vision insurance helps cover the cost of vision expenses, not general eye health
You can purchase vision insurance through your employer or from a carrier directly
Getting vision insurance will help you cover the cost of an eye exam, glasses, or contacts
How Does Vision Insurance Work?
Let’s start with the basics and break down what the typical expenses look like when you have vision insurance.
Vision insurance gives you defined costs for your vision care. Most plans will give you a flat copay for an exam, typically about $10. You’ll also have an allowance to spend on frames and a flat copay for lenses. The lens copay amount will vary depending on the type of lens you need (bifocal, trifocal, coatings, etc.). Most vision plans allow you to use the frame allowance on either frames or contacts lenses.
Vision plans usually cover:
One exam annually
One set of lenses annually
One set of frames every year or every other year
These costs are covered for in-network providers. Similar to medical insurance, you can check for in-network vision providers using the carrier provider search.
Vision plans typically give an allowance toward new frames or contacts annually or every other year. So if you go to an in-network vision provider, you may have $100-$130 to spend on a new set of frames, or if you prefer to wear contacts, you would have that same $130 to put toward your annual spend on contacts. For exact amounts available, refer to your plan document or plan summary.
Some plans may also include discounts on laser vision correction, also known as Lasik. Typically plans include around a 15% discount for in-network Lasik providers. Lasik is often only covered in-network, so be sure to check that your Lasik provider is in-network using your carrier’s provider search.
How Reimbursements Work for Out-of-Network Providers
For out-of-network providers, some vision plans offer reimbursement for eye exams performed at an out-of-network provider or glasses purchased out of network.
This means if you visit an out-of-network provider for your annual vision exam, you will pay that provider at the time of service, and then you would submit the claim for reimbursement to your vision carrier. Some plans will reimburse up to $45 for an eye exam, but the actual reimbursement will vary by plan.
You can check if your plan offers any out-of-network reimbursements by referring to your plan document or looking in the member portal.
Many people prefer to purchase glasses from out-of-network providers. Before doing so, it’s best to look at your plan summary to see how much your carrier is willing to reimburse you for eyewear purchases made at an out-of-network location. This can help you know what to expect when you submit an out-of-network claim.
Can You Get Vision Insurance at Any Time?
If your employer offers vision coverage, you will have the opportunity to enroll once you’re hired (though you may need to wait a couple of months until the probationary period is over). There will be an open enrollment period every year, which allows you to make any changes needed to your plan, such as adding a dependent.
If you don’t enroll as a new hire, you will have to wait until the next open enrollment period to enroll.
If your employer doesn’t offer vision coverage, you can find individual plans from providers and enroll anytime.
Can I Cancel Vision Insurance at Any Time?
Vision insurance policies are usually a one-year contract and require a qualifying life event to terminate. This would mean if you found vision coverage elsewhere, they would allow you to terminate the policy. Note that they will often require proof of other coverage before they will allow the termination.
One example of a qualifying life event would be if you currently have vision coverage through your employer, and you got married and decided to move your vision coverage to your spouse’s employer. You would need to let your current employer know you are moving coverage to your spouse’s policy and then submit a copy of your new ID card for them to process the termination with your carrier.
Can You Have Primary and Secondary Vision Insurance?
Yes, this will work similarly to health insurance. If you are the primary subscriber on a vision plan, that plan will pay first, meaning you will first submit any claims to your primary vision insurance carrier. If you are then listed as dependent on your spouse’s plan, that plan will pay second.
Does My Health Insurance Cover Vision?
Since the Affordable Care Act was put in place, major medical plans offer pediatric vision coverage. This means children under 18 can get an annual eye exam and any necessary glasses covered under your medical plan. See your Summary of Benefits to determine if copays or the deductible apply.
Adult vision is typically not covered under a medical plan. That’s why adding a low-cost vision plan can help you cover the costs for your annual eye exam and new glasses or contacts every year.
Your medical plan does, however, cover general eye health. Ophthalmologists are medical doctors who help treat eye diseases or injuries such as glaucoma or a torn retina. These types of claims would fall under medical insurance, whereas a vision exam and glasses would fall under vision insurance.
Vision insurance is a low-cost way to save yourself some money at the eye doctor. Depending on the plan and how many dependents you have, coverage can cost as little as about $5 per month!
You will usually pay only around $10 for an eye exam and maybe around $25 for lenses with a vision plan. Then you’ll also receive an allowance of $100+ for frames every year or every other year. Some plans have discounts on contacts and Lasik vision correction, so be sure to check your plan document or carrier website to look into those added benefits.