Vision insurance is optional, and it helps to cover the costs of routine and preventative eye care. It bridges the gap between what your health insurance covers and out-of-pocket costs, and most plans don’t have a deductible you need to reach before receiving benefits. A policy typically offers coverage for routine eye exams, and discounts on glasses and contacts for the roughly 75% of Americans who use vision correction, according to the Vision Council of America.
When you’re shopping around for vision insurance, narrow down your options by asking these questions:
How much is the premium?
Does the policy cover an annual eye exam?
Is there a company for basic eye services?
What’s the benefit cap?
What’s the allowance for frames and contact lenses?
Can I get new frames every year, or is it once every two years?
Is there an allowance for bifocal, trifocal and specialty lenses?
Does the policy cover pre-existing conditions?
Does the policy cover lens enhancements, like anti-glare lenses?
Is my eye doctor in my insurer’s network?
Where is the nearest in-network provider?
Do I need a referral to see an out-of-network eye doctor?
Is there a waiting period?
Does the plan have an enrollment fee?
How much does vision insurance cost?
You can expect to pay around $17 per month for an individual vision insurance policy, according to Vision Service Plan (VSP) — the biggest provider in the US. This comes to $204 a year.
You may pay more if you choose a plan with a larger network of eye doctors, or if you live in a state with higher vision insurance rates.
Some insurers charge an enrollment fee when you sign-up, so account for this when considering the total cost of the policy.
What does vision insurance cover?
Vision insurance usually covers basic preventative care, including annual eye exams and vision tests. Unlike health or dental insurance, vision insurance benefits don’t always reset every 12 months. Your insurer might only pay for a new pair of glasses up to a certain dollar amount or once every 12 to 24 months.
Your policy may also pay for a portion of these vision correction expenses:
Lens enhancements, like lightweight or nonreflective lenses
What’s not covered by vision insurance?
Vision insurance is designed to cover key eye-care expenses. It doesn’t apply to these costs:
Enhanced lenses, like progressive, trifocal, transition, nonreflective or impact-resistant lenses
Metal eyeglass frames
Medications, like eye drops to treat pink eye or glaucoma
Medically necessary surgery, like surgery to remove cataracts
Eye treatments for diabetic retinopathy or macular degeneration
Some policies offer discounts for elective procedures, such as LASIK or PRK surgery — but these aren’t usually covered entirely by vision insurance.
How to get vision insurance
You can buy vision insurance year-round in most cases, and there are a few ways to get coverage:
Sign up for a policy through your employer. Many employers offer vision insurance as part of their workplace benefits package. Your premiums will be subsidized, making this a cost-effective option — but you’ll need to opt in during open enrollment.
Add a vision rider to your health or dental insurance. Depending on your insurer, you may be able to add coverage for routine eye exams and get an allowance for prescription glasses and contacts. But you might have to meet a deductible to access these vision benefits.
Purchase a standalone policy on your own. To get the best coverage at the lowest price, take the time to compare policies from a range of vision insurance companies. By going directly through an insurer, you’ll be able to customize your benefits.
Apply for coverage via the Health Insurance Marketplace. Thanks to the Affordable Care Act (ACA), you can apply for a low-cost health insurance policy that offers vision coverage through the government. To explore this option, head to Healthcare.gov.
How does vision insurance work?
When you sign up for vision insurance, you’ll pay a monthly or annual premium to maintain your coverage — and policies last at least 12 months.
Depending on the plan you have, you may need to pay a small copay when you visit an eye doctor. But vision insurance is unique in that you don’t need to meet a deductible before your insurance company steps in. Instead, your insurer will offer a set amount of money to put towards the costs of preventative eye care — like eye exams — and prescription eyewear. This is known as the benefit amount or allowance.
Every policy has a benefit cap, which is the maximum amount you can spend. If you reach that number, you’ll pay for any other eye care expenses or services out-of-pocket until you renew your policy. So, if your insurer has a $100 allowance for glasses, but you want to buy a pair that costs $400, you’ll pay $300.
Some plans require you to see an in-network doctor, which means your insurance company won’t cover the bill if you go to someone out-of-network. You can find out how flexible your plan is by reading through your policy documents.
Do vision insurance policies have a waiting period?
Generally, no. But some policies have waiting periods ranging from 30 days to 36 months, which means you’ll receive few to no benefits from your policy during that time.
From an insurer’s perspective, the purpose of the waiting period is to encourage people to buy vision insurance before they have expensive eye care needs.
Which type of vision insurance is right for me?
Most vision insurance policies are set up as PPOs, but HMOs and Indemnity Plans are also available. Their differences come down to costs and flexibility with out-of-network providers.
Type of plan
How it works
Specialist referrals required
Preferred Provider Organizations (PPO)
Pick any dentist and get discounts for going in-network
In-network dentists are cheaper
Usually no copays
Flexibility and no copays
Health Managed Organizations (HMO)
Visits to your primary dentist are covered, though you might need to work or live within the service area
Copays for visits
Yes — your primary dentist will refer you to an in-network specialist
Affordable in-network care
Pay the same price for going to any dentist
No negotiated bill discounts
See any doctor for a higher cost
Vision insurance glossary
These are the key terms you may come across when shopping for vision insurance:
Allowance (aka benefit amount). The amount of money your insurer allocates to specific eye-care expenses.
Benefits. The services and expenses covered under your vision insurance policy.
Benefit cap. The maximum dollar amount your insurer puts towards eye-care expenses while your policy is in effect.
Copay. A set rate you’re charged for specific eye-care visits or services. For example, you might pay a $10 copay for an eye exam and $25 for a contact lens fitting.
Enrollment fee. A one-time fee some insurers charge when you sign up for a policy.
In-network provider. An eye doctor that’s partnered with your vision insurance company to offer services at pre-negotiated rates.
Limitations. The restrictions associated with your plan.
Optometrist. An eye doctor who’s licensed for primary eye care. They can perform exams and vision tests, treat conditions like nearsightedness and prescribe glasses and contact lenses.
Ophthalmologist. An eye doctor who specializes in medical and surgical eye care.
Out-of-network provider. An eye doctor who isn’t tied to your vision insurance company and so doesn’t offer discounted rates.
Out-of-pocket costs. Eye-care expenses that aren’t covered by your insurer, including copays.
Premium. The monthly or annual fee you pay in exchange for vision coverage.
Routine care. Eye care exams and other services that help maintain eye health and diagnose issues before they become serious.
Waiting period. The time you’ll need to wait before you can access certain eye-care services.
Is vision insurance worth it?
There isn’t a one-size-fits-all answer. While vision insurance is an inexpensive type of coverage, its value comes down to your eye health and financial situation.
If these situations apply to you, a vision insurance policy could cut the costs of your eye care significantly:
You need glasses or contacts
You need corrective vision surgery
You have a family history of eye disease, like glaucoma
You have a medical conditions that increases your risk for eye disease
You’re over 60
You’re looking into an elective eye procedure, like LASIK
On the other hand, you may not have as much of a need for vision insurance in these cases:
You have HSA or FSA dollars to spend
You have a robust health insurance plan
You have the savings to cover your annual eye exam and new glasses or contacts.
How much are opthalmologist visits if I’m uninsured?
These are the average costs for common eye care services, according to Fair Health and VSP. This will give you an idea of how much you could save with vision insurance.
Eye exam: $152
Eyeglass frames: $238
Basic single vision lenses: $113
Refractive vision test: $46
Alternatives to vision insurance
If vision insurance isn’t the right fit, consider these alternatives:
Look into a vision discount plan. These plans work as memberships, and they have a network of participating providers. You’ll pay a monthly or annual fee to qualify for discounted rates on eye care products and services, and you’ll pay the provider directly. The discounts typically range from 15% to 35%. While the premiums are lower than that of vision insurance, the coverage is limited.
Pay out-of-pocket. If you have the savings to self-insure and don’t anticipate any major eye problems, you can choose to pay 100% out-of-pocket. But know that you won’t have access to the prenegotiated rates and discounts that come with vision insurance and vision discount plans. Most eye doctors accept cash, debit card and credit card payments.
An optional policy, vision insurance can help to offset the expenses of eye care and services — like eye exams, glasses and contact lenses. The coverage is on the cheaper side, but if you have healthy eyes and don’t need prescription eyewear, you may be able to skip it.
If you’re interested in vision insurance, compare policies to get the coverage you need at an affordable price.
Frequently asked questions
Health insurance covers the treatment of eye diseases, such as amblyopia, glaucoma, cataracts, diabetic retinopathy and age-related macular degeneration, according to America’s Health Insurance Plans (AHIP).
It also pays for eye care related to injuries or pre-existing medical conditions, like complications that arise from high blood pressure. Health insurance 101
You can use your Health Savings Account (HSA) or Flexible Spending Account (FSA) to cover some vision-related costs, like eye exams, contact lenses and prescription glasses and sunglasses.
To avoid any surprise charges, double-check what your account covers before you visit an eye doctor.
Adults should get a comprehensive eye exam every two years until they reach age 60, and every year after that, according to the American Optometric Association (AOA). If you have a history or genetic risk of any eye diseases such as glaucoma, get an annual visit.
The AOA recommends that children get eye exams at these intervals:
At six months old
Once between the ages of three and five years old
Annually from six to 17 years old.
No — vision insurance isn’t legally required under the ACA.
Yes. You don’t need to have health insurance in place to buy vision insurance.
But keep in mind that eye diseases and eye injuries are considered medical problems and are covered under health insurance.
Medicare doesn’t cover eye exams for glasses or contact lenses — so you’ll need to pay 100% of those costs.
Medicare Part B (Medical Insurance) covers the following for high-risk policyholders:
One eye exam for diabetic retinopathy per year.
One glaucoma test per year.
Certain diagnostic tests and treatments for age-related macular degeneration (AMD).
The 20% Part B deductible applies, and you’ll pay a copay if you go to a hospital for these services.
Medicaid programs vary between states, but they generally cover:
Routine and comprehensive eye exams
Glaucoma screenings for those at high-risk for glaucoma
Eyeglasses — including frames, lenses, fittings, repairs and replacements once a year
Medically necessary contact lenses
If your current eye doctor is out-of-network, you may be able to nominate them for membership with your insurance company.
The process varies between insurers, but typically, you’ll need to fill out a nomination form from your insurer. They’ll then send an application to your eye doctor, who has up to 12 weeks to return it.
If your eye doctor chooses to join the network, you’ll be able to claim your visits and some costs under your vision insurance plan.
If you go to an in-network eye doctor, they’ll submit the claim on your behalf. Insurers usually approve claims within 30 days, and send you an Explanation of Benefits for reference.
If you received eye care from an out-of-network provider, you’ll need to submit a claim on your own.
The process varies between insurers, but these are the basic steps:
Request a claims form from your insurer.
Complete the claims form. Fill out your eye doctor’s name, the date of your visit, the services you received and how much you paid.
Mail the form back to your insurer, along with an itemized receipt from your eye doctor.
Katia Iervasi is a staff writer who hails from Australia and now calls New York home. Her writing and analysis has been featured on sites like Forbes, Best Company and Financial Advisor around the world. Armed with a BA in Communication and a journalistic eye for detail, she navigates insurance and finance topics for Finder, so you can splash your cash smartly (and be a pro when the subject pops up at dinner parties).
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