When selecting a health insurance plan, you may also want to purchase a supplemental vision insurance plan to obtain medical care for your eyes. Health insurance plans usually only cover eye care if you’ve got a major medical issue, so purchasing a vision insurance plan to help with the cost of eye exams and prescription eyeglasses or lenses could be a good option for you. Learn about the various vision insurance plans available so you can select the best vision insurance plan for you.
Vision insurance plans typically offer eye care benefits and are available either as additions (referred to as optional riders) to your major health insurance plan or through an ancillary plan (a separate, secondary insurance plan that offers benefits usually not available through major health plans, like vision, dental, and short-term disability benefits).
Many health insurance plans offer optional vision benefits packages (optional riders). These vision benefits are generally available for an extra premium (typical averages in recent years are $170 per year for an individual and $430 per year for a family) and give beneficiaries access to a fixed-dollar amount of services. Vision benefits packages function similarly to a typical health insurance plan, requiring a copayment (generally $10 to $25), with each plan placing limits on how much it will pay for each service. If you require contact lenses, for example, your vision insurance plan may only pay up to a certain amount for the lenses and require you to pay the difference out-of-pocket. Also, this type of vision insurance plan usually does not fully cover elective eye surgery like LASIK.
Ancillary plans, on the other hand, are separate vision insurance plans that usually give a pre-determined discount (20% for example) on all vision-related expenses. Ancillary vision insurance plans are generally more affordable than vision benefits packages, with annual premiums in recent years of about $70 for an individual and $150 for a family. If your eye care needs are limited, meaning that you require one eye exam per year, for example, or one new set of eyeglasses per year, an ancillary plan may be the best vision insurance plan option for you.
Do keep in mind that both types of vision insurance plans may carry annual deductibles, which you will have to meet before your vision benefits kick in. Also remember that it’s always more affordable to visit a network doctor rather than an out-of-network provider.
When selecting the best vision insurance for your specific needs, it’s important to know that the majority of vision insurance plans usually cover the following services, according to AllAboutVision.com:
Under the Affordable Care Act (ACA, also referred to as ObamaCare), all Qualified Health Plans (insurance plans certified by the Health Insurance Marketplace) are required to offer pediatric vision coverage, including an annual eye exam and some material benefits (like eyeglasses), for all patients under the age of 19. However, most Qualified Health Plans do not offer adult vision coverage, such as coverage for any refractive errors or mild eye diseases like conjunctivitis. If you need adult vision coverage, including coverage for an annual eye exam plus material benefits (eyeglass lenses, eyeglass frames, partial coverage for LASIK procedures, and so on), it’s probably a good idea for you to purchase a vision insurance plan.
If you have a major eye disease however, including glaucoma, cataracts, amblyopia, strabismus, diabetic retinopathy, and age-related macular degeneration, you can receive coverage for your eye disease through Qualified Health Plans, because all of these ailments are generally considered to be medical problems and can be billed to your medical health plan. Many medical health plans will also cover eye surgery when necessary, most commonly for glaucoma and similar eye diseases.
You can explore your options for vision insurance plans by clicking the button on the right side of this page. And, we invite you to sign up for our newsletter on the right side of this page as well—it’s filled with health- and insurance-related updates.
Note: This information is just a general summary of factors to consider and may not reflect the provisions of any particular insurance product. Always carefully check the provisions of any insurance product you have or may consider purchasing.