Jane Dotson
Vision insurance is a type of health insurance that covers eye care services and products. It typically includes coverage for routine eye exams, glasses, and contact lenses, and may also provide discounts on other vision-related expenses. Vision insurance plans can vary widely in terms of their benefits and costs, and it's important for individuals to understand their specific coverage to avoid unexpected financial responsibilities. Some common vision insurance providers include UnitedHealthcare, EyeMed, and Aetna, which offer a range of individual and family plans with different coverage options.
| Characteristics | Values |
|---|---|
| What does vision insurance cover? | Routine eye exams, glasses, contact lenses, prescription sunglasses, LASIK or PRK refractive surgery. |
| How to check vision insurance benefits? | Online, by calling your provider, using a mobile app, or calling the number on the back of your vision insurance card. |
| Vision insurance providers | EyeMed, Aetna, Blue Cross Blue Shield, Superior Vision, UnitedHealthcare, MyEyeDr. |
| Vision insurance plans | FSA, HSA, VSP, Davis Vision, Spectera, Dental Direct plan. |
| Vision insurance exclusions | Charges in excess of benefits, special vision procedures (orthoptics, vision therapy, or vision training), non-prescription lenses or sunglasses, two pairs of glasses in lieu of bifocals, medical and dental exclusions. |
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What You'll Learn
What does vision insurance cover?
Vision insurance covers the costs of routine eye care, including eye examinations and prescriptions for correcting vision errors. The frequency of eye examinations covered varies, with some plans offering annual and others biannual check-ups. Vision insurance also covers the cost of prescription eyewear, including eyeglass lenses and frames, as well as contact lenses. Some plans offer a set annual amount or discounts for contact lenses, while others provide an allowance for eyewear. Vision insurance can be purchased as a standalone plan or combined with other supplemental coverage, such as dental insurance. It is worth noting that vision insurance typically does not cover eye exams considered "medical", including vision loss, floaters, dry eyes, allergies, infections, and eye diseases.
The specific benefits of vision insurance depend on the insurer and the chosen plan. Basic vision insurance plans typically include eye exams, contact lenses, and eyeglasses, while more comprehensive plans may offer discounts on eyewear upgrades, such as transition lenses, anti-reflective coating, and progressive lenses. Vision insurance can also provide access to nationwide networks like EyeMed or VSP, offering exclusive discounts on surgical corrective procedures such as LASIK and PRK.
It is important to review the insurance contract to understand the details of your vision coverage. The cost of vision insurance also varies, and it is recommended to choose a plan that fits your needs and budget. Vision insurance is a valuable investment in your overall health, as eye doctors can detect early indicators of serious health issues like cancer and diabetes during routine eye exams.
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What are the best vision insurance providers?
Vision insurance typically covers routine eye care costs, such as eye exams, glasses, and contact lenses. It is important to understand what your vision insurance covers and what your financial responsibilities are to avoid unexpected costs. When choosing a vision insurance plan, consider the number of eye doctors in the provider network, the services and products covered, and whether there are any allowances for upgrades.
UnitedHealthcare
UnitedHealthcare offers vision insurance plans with a variety of individual coverage options. Their plans are accepted at over 120,000 access points and offer benefits such as low-cost coverage, a large provider network, and an annual $150 frame or contact allowance. Their policies also provide discounts on laser surgery at select locations.
EyeMed
EyeMed is one of the largest vision insurance providers, with over 70,000 providers and locations. They offer family plans and are known for their affordability. EyeMed policies provide discounts on retail prices for laser surgery.
VSP Vision Care
VSP Vision Care is another large vision insurance provider, used by one in four Americans. They offer nationwide availability and have been praised for their coverage of exams and glasses/contact lenses, with low out-of-pocket costs.
Anthem’s Blue View Vision Enhanced
Anthem’s Blue View Vision Enhanced offers competitive monthly rates and benefits, including a $10 copay for exams, glasses, and contacts, and an annual $150 frame or contact allowance. However, they have fewer in-network providers compared to competitors.
Direct Vision
Direct Vision is a good option for those seeking affordable vision insurance.
Davis Vision
Davis Vision offers plans starting at just over $12 per month, with a small copay for an annual comprehensive eye exam. They provide an allowance for eyeglasses or contact lenses and may offer discounts on LASIK procedures and specialty eyewear. Davis Vision also offers an unconditional warranty, replacing broken frames or lenses within the first year of purchase at no cost.
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Does Medicaid cover eye exams?
Medicaid is a federal program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. While the federal government establishes overarching rules for Medicaid, each state runs its own program, including determining eligibility and coverage policies.
For children, federal law mandates that Medicaid-enrolled infants, children, and adolescents have access to appropriate and medically necessary services, including vision services, to correct and ameliorate health conditions. However, Medicaid coverage for eye exams and vision services for adults varies widely by state.
In some states, fee-for-service Medicaid policies do not cover glasses or eye exams. Certain states, like Arizona, Idaho, New Mexico, Oklahoma, Tennessee, West Virginia, and Wyoming, have no coverage for exams or glasses under either fee-for-service or managed care policies. Additionally, many states do not cover low vision aids such as magnifiers and loupes.
On the other hand, some states do provide coverage for routine eye exams and vision services. For instance, Molina Healthcare in Illinois covers one routine eye exam per year by a provider, ophthalmologist, or optometrist, and provides coverage for a pair of eyeglasses every two years.
It is important to note that even in states with coverage for vision care services, enrollees may face barriers due to copays and restrictive policies. Therefore, it is advisable to review the specific coverage policies of your state or insurance provider to understand what eye care services are included in your Medicaid plan.
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How often can I get new glasses or contacts with insurance?
The frequency with which you can obtain new glasses or contact lenses with insurance is determined by the specifics of your insurance plan. Most vision insurance plans provide coverage for both eyeglasses and contact lenses, but individuals typically have to choose between using their benefits for one or the other.
Some plans offer a set annual amount or allowance for contact lenses, which can vary by provider and plan type. Basic plans might offer $150 per year, while more comprehensive coverage with higher premiums may provide higher allowances. Certain plans may also cover the cost of a contact lens exam annually or require a small copay.
For eyeglasses, insurance plans may provide an allowance for frames and lenses once every 12 months or only for frames once every 24 months from the last date of service. The frequency can vary, with some plans covering new glasses every one to two years. It is worth noting that prescriptions for eyeglasses typically expire after one or two years as well.
It is important to review your specific plan details or consult your insurance provider to understand the allowances, discounts, and timeframes applicable to your coverage. Factors such as wear and tear, fashion preferences, and the desire for multiple pairs can also influence how often individuals choose to get new glasses or contacts, regardless of insurance coverage.
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What if my insurance doesn't cover my eyewear?
If your insurance does not cover your eyewear, you can consider the following options:
Vision discount plan
Vision discount plans are an alternative to traditional vision insurance. For an annual premium or membership fee, you gain access to a network of eye care providers that offer discounted rates on their products and services. This can be a more affordable option if you don't require extensive eye care and want to save money on your eyewear.
Standalone vision plan
Vision insurance plans can be purchased separately from your health insurance. You can explore standalone vision plans offered by companies like UnitedHealthcare, which provide a range of coverage options for eye exams, contacts, glasses, and more. These plans can help you manage the costs of eye care that may not be covered by your health insurance.
Supplemental plans
In addition to standalone vision plans, you can also consider combining your vision coverage with other supplemental plans, such as dental insurance. By bundling these plans together, you may be able to find more affordable options that offer the coverage you need for your eyewear.
Online retailers
Online eyewear retailers like eyebuydirect, GlassesUSA, and Zenni offer high-quality glasses and prescription sunglasses at significantly lower prices than traditional optical stores. In some cases, you may find that purchasing eyewear online is more cost-effective, even without insurance coverage. Additionally, some online retailers have partnerships with specific insurance companies, so it's worth checking if your insurance can be used on their website.
Compare insurance plans
If you haven't already chosen an insurance plan, it's worth comparing multiple options to find one that covers eyewear. Vision insurance benefits can vary widely between plans, so it's important to understand what is covered and what your financial responsibilities will be. Consider factors such as the number of eye doctors in the provider network, the specific products and services covered, and any allowances for upgrades or discounts.
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Frequently asked questions
You can check if you have vision insurance by contacting your insurance provider directly. You can also call the number on the back of your vision insurance card.
Vision insurance typically covers routine eye exams, glasses, and contact lenses. Coverage may also include prescription sunglasses, eyeglasses, and discounts on eye care products and services.
Most vision insurance plans provide benefits for glasses or contacts once every 12-24 months, depending on the specific plan.
