As many as 16 million people in the United States have undiagnosed or uncorrected vision impairments that could be fixed with eyeglasses, contact lenses or surgery.
Vision insurance, vision savings plans, and vision discount plans may help you and your family save on vision care. Find out which option is best for you and compare their coverage of vision exams, glasses frames, lenses, contact lenses, and laser eye surgery.1
Why do I need vision coverage?
Reducing the out-of-pocket expenses for eye care is the primary reason for vision care insurance, vision savings plans, and vision discount plans. While there is a monthly fee for vision insurance, the price of treatment for vision loss and the inability to work would have a much greater cost.
The need for glasses and contact lenses, in addition to routine examinations to detect diseases of the eyes, is a need shared by millions. The CDC estimates that 93 million adults in the United States are considered at high risk for loss of their sight, but only half had an examination by an eye doctor in the past year.2
Even if you do not currently need corrective glasses or contact lenses, having vision insurance or a vision discount plan is important for your eye health. Preventable vision loss causes major economic hardships, job loss, and a lowered quality of life. Most Americans do not seek eye care due to either a lack of awareness of the importance of routine eye care or because of the cost.
Many serious eye diseases do not have any early warning signs. Regular examinations by a licensed optometrist or ophthalmologist can detect conditions like glaucoma or diabetic retinopathy before they cause permanent damage.
What does vision insurance cover?
As with other insurance, such as health and dental, vision insurance pays a portion of the expenses associated with eye care and corrective products. It typically covers eye exams, as well as products to correct vision, such as prescription glasses, sunglasses and contact lenses. Some vision insurance plans also offer discounts on LASIK and other elective vision correction surgery. Not having vision insurance can cost you hundreds of dollars each year in eye care expenses.
Depending on the specifics in the policy you purchase, vision plans vary in what they cover and how much they pay for services. Basic plans usually cover these services:
- Eye examinations and vision tests
- Prescription eyeglass frames and lenses
- Contact lenses
- Lens protection, such as scratch-resistant coatings
The more services that the plan covers, the higher the monthly premium may be. In addition to the basic services listed above, some policies also cover these value-added products:
- Disposable contact lenses
- Progressive lenses
- High-index lenses
- Photochromatic lenses
- Anti-reflective coatings
- Polarized sunglasses
- Some eye surgery procedures
In addition to a monthly premium, you will usually pay a portion of the charges. Some policies also include a deductible—the amount you must pay out of pocket before the insurance starts to pay a benefit.
Vision insurance and vision discount plans both can include access to a network of eye care professionals, such as optometrists or ophthalmologists, who have signed up with the company to provide vision care to participants at reduced prices. In some cases, other specialists such as eye surgeons may also join the network as a provider. It is important to consider the network providers that are located close to your home and the size of the network when considering purchasing a vision insurance policy or joining a vision discount plan.
What is a vision discount plan?
Vision insurance functions much like traditional health insurance. It is often added to an employer’s benefits package with premiums deducted from your paycheck. The policy then covers a certain percentage or flat fee for vision services, usually with a deductible applied.
On the other hand, a vision discount plan, also called a vision savings plan, offers a discount on vision services and is used much like a buyer’s club card. When you join a vision discount plan, you become a member of a large group that has negotiated discounted fees with a network of eye care providers.
Vision discount plans and vision savings plans usually cost less per year than traditional vision insurance, but you may pay more out-of-pocket for eye care visits and corrective glasses or contacts.
In a vision discount plan, you pay an annual membership fee or premium. Eye care providers, who have signed up as network participants, promise to give you discounted fees for their services. Using your discount membership, you can get basic vision care services at a reduced fee, and some plans also cover elective vision correction surgeries.
Some vision discount plans allow you to access services from eye care professionals who are not in the network. When this happens, you must pay in full for the services then request reimbursement from the company. This is an issue you should clarify when joining a discount plan, especially if you travel a lot and may frequently need to access services outside the network.
The cost of a discount vision plan depends on the level of coverage you want, the number of family members you want to include, the amount of the discount, and whether you are looking for an individual plan or one associated with a group. Individual plans typically have a higher premium or membership fee than group plans.
How is a vision discount plan different from vision insurance?
Vision insurance, many times, is an addition to an employer-sponsored benefits package. Whether the health insurance is a traditional indemnity plan, a health maintenance organization (HMO), or a preferred provider organization (PPO), vision benefits are usually added as a choice for the employee to opt into. The health insurance provider may have contracted with a managed vision care network to provide eye care services to the employee group.
Vision insurance offers either a vision benefits package or discounts on eye care. They usually require that you pay a deductible and a copay at each visit.
With a vision discount plan, you pay fully for services but receive a discount on the fees. The eye care providers who participate in the discount plans have agreed to charge a lower-than-normal price for services provided to the members of the plan.
Each type of coverage, whether employer-provided, traditional vision insurance, or a vision discount plan, covers a different set of services at varying rates. When shopping for a plan, be sure it covers the services you and your family members need. If you wear glasses, find out the coverage for frames and lenses; if you wear contact lenses, find out how often you can have them replaced and what types of lenses you can purchase.
If you cannot get a group plan where you work or are self-employed, insurance companies offer individual vision plans to help save you money at the eye doctor, especially if you have a large family or frequently need eye care.
Are there limitations on what vision insurance covers?
Some eye conditions, such as cataracts, glaucoma, or retinal detachments, are considered medical conditions. These are usually covered by your health insurance rather than vision insurance or vision discount plans.
Other limitations typically found with vision insurance include the following:
- Basic lenses for glasses - You plan may pay only for basic lenses or bifocals. You may have to pay for any enhancements such as anti-glare or lightweight lenses.
- Limitation on frame cost - If you want expensive designer frames, you will have to pay for the costs that are over the maximum allowed for frames. Some plans allow a flat rate for frames and, if you purchase ones that cost more, you will pay for any costs over and above the allowable rate.
- Benefit period limitations - Plans might provide coverage for either glasses or contacts, but not both, during the benefit period. For example, you could get glasses one year and contacts the next but not both in the same year.
- Pre-existing conditions - Some pre-existing conditions—those that an eye care professional diagnosed prior to the start of the vision insurance policy or before you joined the plan—may not be covered. Although a pre-existing condition will not keep you from purchasing a plan, that specific condition might be excluded from treatment by the policy.
Limitations to vision insurance policies and vision discount plans are important to note prior to signing up.
Which is better: vision insurance or a vision discount plan?
The best place to start making the decision about what type of vision coverage is best for you and your family is to look back at the past couple of years to see what you have spent on eye care. This will give you a good idea of what you can expect to spend in the immediate future.
Consider the monthly premiums, co-pays, and maximum benefits offered by a vision insurance policy. Then ask if there were some vision services or products that you either wanted or needed but could not afford during your last visit to the eye clinic. If you had an insurance policy that covered those items, you might have opted to have the enhanced service or value-added product, such as graduated lenses or a more fashionable frame.
Then consider the vision discount plan. How much does it cost to join? How much of a discount can you expect for services and products? Make sure the discount is enough to off-set the membership fee to join the plan.
With both vision insurance and vision discount plans, it is important to find out if there are in-network providers nearby and if your optometrist or ophthalmologist participates in the network.
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This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.