Vision insurance plays an enormous role in maintaining a lifetime of healthy vision for many people. A good plan can take care of costs that might otherwise get in the way of managing eyecare. In a lot of ways, vision insurance supports the first line of defense - preventative care - for your eyes.
But unfortunately, there are a large number of questions and misunderstandings surrounding the benefits and application of vision insurance that leave some individuals on the fence about their coverage needs. This uncertainty is a big reason why - according to a consumer study by The Vision Council VisionWatch 1 - only half of the American population finds it necessary to have a vision insurance plan in the first place…let alone use it.
So what is vision insurance, and how does it differ from general health insurance?
The Importance of Maintaining Healthy Eyes
As you'd probably guess, vision insurance is meant to cover the costs associated with visits to the eye doctor. While that sounds straightforward, the actual coverage you receive tends to be a bit more nuanced.
The vast majority of supplemental vision insurance plans do not cover all types of eye visits. Specifically, vision insurance is concerned with preventative eye care services and vision correction products. Eye doctor visits that fall under the wings of your vision insurance are meant to evaluate your vision, determine what sorts of lenses will best correct your eyesight, and catch any harmful eye and health conditions you might not be aware of.
That last benefit is important. Some of the most common and debilitating eye diseases - such as macular degeneration and glaucoma - will not show any noticeable symptoms until irreversible damage has already begun. Dietary choices 2 are a big factor in developing these harmful eye conditions, but other aspects like genetics can be completely out of your hands. The only way to catch the warning signs before it's too late is to have a professional take a look at your eyes at least once a year. By acting early enough, eye diseases can often be detected and addressed early on.
You're only gifted with one pair of eyes when you're born. Thus, it's very important to take care of them; not only for how they feel in the moment, but also because you want to minimize the danger of any problems that might arise in the future.
Vision insurance helps make eye doctor visits and your eyewear more affordable.
Regular visits to the eye doctor are your best bet to safely monitor your vision as you age and become more susceptible to the onset of eye diseases.
What Does Vision Insurance Cover?
Just about anything that is considered “routine” during your visits to the eye doctor is covered by most vision insurance plans. This usually includes an annual eye exam and most eyewear needs.
A yearly eye exam is essential for keeping tabs on the condition of your eyes and vision. The eyes of adults typically do not change rapidly from year to year, so any noticeable differences can alert a doctor to something that might be wrong. This makes annual eye exams an ideal interval to check in with a professional and make sure everything is okay.
Eyewear covered by vision insurance will generally include glasses or contact lenses. Because you'll usually want to get new glasses every year, a good vision plan can help you afford the bills whenever you're looking for your next pair. Plans typically include discounts on lens enhancements like anti-glare, progressive lenses, and light-to-dark tinting. Frame allowances typically range from $120 to $150. Vision insurance is also very useful for wearers of contact lenses. Most contact lens distributors will not allow you to purchase boxes of contacts unless your prescription has been updated within the last year. The charges for these consistent updates will gradually add up, so a plan that helps cover those costs can pay for itself rather quickly.
What Does Vision Insurance Not Cover?
Besides knowing what vision insurance covers, it's equally important to be aware of what it does not cover.
Vision insurance generally does not cover any visit or procedure that is medical in nature rather than routine. If you don't have any problems with your eyes or vision (besides being near- or far-sighted), your trips to the eye doctor will likely be considered routine and your vision insurance will be used. If the doctor notices something concerning during your exam that could require medical attention, either now or in the future, good vision insurance plans will still accept your claim for that visit. Moving forward, however, your visits might fall under your medical coverage instead of your vision insurance.
Be aware that vision insurance also won't cover non-prescription reading glasses and may not cover repairs or replacements for your eyewear.
Visiting the Optometrist vs. Visiting the Ophthalmologist
Many owners of vision insurance are not fully aware of their eye doctor's profession. As it turns out, this has a lot to do with the application for vision insurance. Most vision insurance plans will only cover services provided by an optometrist.
An optometrist, or an OD, is able to provide the standard selection of eye care services that you are probably already familiar with. This includes conducting an exam on your eyes, diagnosing any visual shortcomings (like presbyopia and myopia: far- and near-sightedness, respectively), and treating these issues. You go to an optometrist for any services related to prescription eyewear.
On the other hand, an ophthalmologist, or an MD, is concerned about the inner workings of your eyes and any underlying problems you might be experiencing. These doctors are familiar with ocular diseases and are often surgeons as well. Specialized treatment of conditions like cataracts, macular degeneration, or glaucoma will usually call for an ophthalmologist to take a look.
Vision insurance may not cover medical care you receive from an ophthalmologist, so keep that in mind when browsing your coverage options. Optometrists will always reserve the right to refer you to an ophthalmologist if they find something troubling during one of your visits. Likewise, if you see an ophthalmologist for your routine eye exams, they might also decide to flip your visit from routine to medical if they deem it necessary.
What Are Some Types of Vision Insurance?
There are generally three types of vision insurance plans. Each differs slightly in its offered savings and its application.
Routine Coverage (typically referred to as separate “vision insurance plans”) offers insurance with a number of eye care providers within its network, while out-of-network providers will have limited or no coverage. Nevertheless, routine coverage allows you to venture outside of its network if you like. For example, VSP® Vision Care, one of the largest and most well-known providers of vision insurance, offers effective routine coverage for individuals and through employers.
Healthcare Vision Coverage (Health Maintenance Organization Plans, or HMOs) requires you to pick a primary care provider and receive referrals from them for eye care providers within the plan's network. Seeing as they aren’t independent, healthcare vision plan costs are included in the premiums of the overall health insurance package.
Medicare Coverage (Point of Service Plans, or POS) will have you select a primary care provider and requires referrals to in-network eye care providers for the coverage to kick in, similar to a healthcare vision plan. However, Medicare plans don’t normally cover routine vision care costs, meaning you’ll need to pay out-of-pocket for annual eye exams or new glasses.
1 How Many U.S. Adults Have Vision Insurance or Managed Vision Care?
by: Review of Optometric Business, July 2020
2 Nutrition and Eye Health
by: John G. Lawrenson, and Laura E. Downie
published: National Library of Medicine - National Center for Biotechnology Information, September 2019