When purchasing a health insurance plan, many Americans opt for supplemental vision insurance to get medical care for their eyes. Generally, health insurance plans only cover eye care in case of major medical problems, so beneficiaries who need regular eye exams and prescription eyeglasses or lenses often decide to add vision insurance to their coverage. If you’ve purchased vision insurance, there are many ways to take advantage of your coverage and maximize your vision benefits. Find out what kind of benefits you can receive with vision insurance, and understand how to maximize these benefits.
Under the Affordable Care Act (ACA, also referred to as Obamacare), most Qualified Health Plans (insurance plans certified by the Health Insurance Marketplace) are not required to offer adult vision coverage. If you need adult vision coverage, including coverage for an 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.
There are two main types of vision insurance plans. The first is an optional rider, and it’s a vision benefits package added on to a regular health plan. This type of vision insurance plan is generally available for an extra premium (in recent years, typically around $170 per year for an individual and $430 per year for a family on average) and gives beneficiaries access to a fixed-dollar amount of services. Each plan places a limit on how much it will pay for each service.
The other kind of vision insurance plan is an ancillary plan, which is a separate vision insurance plan that gives a pre-determined discount (20% or 30% for example) on all vision-related expenses. An ancillary vision insurance plan is generally more affordable than an optional rider, because an ancillary plan has premiums that in recent years have been in the range of about $70 for an individual and $150 for a family per year. Note that 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 better vision plan option for you.
Vision insurance coverage varies according to the vision plan you select. Generally though, optional riders and ancillary plans for vision insurance both offer the following benefits, according to AllAboutVision.com:
Once your vision insurance kicks in, the first thing to do is make an appointment with an optometrist or ophthalmologist for an eye exam. Usually, vision plans cover one routine exam per year, plus eye exams that are for actual medical problems. Be sure to bring your insurance ID with you to the doctor’s office, because you may need pre-authorization for the eye exam. After the doctor determines the refractive state of your eyes, he or she can also help you pick out eyeglass frames and lenses or contact lenses, if they’re available on site.
Be aware that if you choose an out-of-network provider, most vision plans will require you to pay for the eye exam, eyeglasses, and so on, and then submit the appropriate forms for partial reimbursement. It’s generally more affordable to choose a network provider, so this may be a better option to fully take advantage of your benefits.
LASIK and PRK, both of which are common forms of laser eye surgery to correct refractive errors, are partially covered by many vision insurance plans. If you do have a refractive error, you may want to consider surgery to deal with the problem once and for all. In fact, recent findings suggest that vision loss associated with contact lenses poses a greater risk than laser eye surgery, so you may want to weigh a laser eye procedure as a viable option. In addition, since laser eye surgery often costs $4,000 on average for both eyes, you’d be saving a great deal of money by having the surgery performed once you have vision insurance versus the annual cost of contact lenses. This would allow you to make the most out of your vision plan, while saving a great deal of money on eye surgery.
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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.