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Understanding Eye Insurance: FAQs and Everything You Need to Know

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According to the World Health Organization, every one of us can expect to experience an eye condition at some point in our lives. With more than 2 billion people in the world in need of vision correction—a number growing by the day—the importance of regular eye exams cannot be overstated. 

Vision insurance is meant to help with the cost of these exams and prescription eyewear. However, given all the systems at play, it can be hard to understand exactly how vision insurance works. You might be wondering how it differs from general health insurance, how much money it might save you, and whether it’s worth paying premiums if you don’t know whether you’ll need glasses or contacts in the future. 

Our guide to vision insurance will address these questions and more. If you’re asking yourself, “Should I get vision insurance?

Eye insurance, also known as vision insurance, is a specialized type of coverage designed to help you manage the costs associated with eye care and vision correction. Just like medical or dental insurance, eye insurance provides financial assistance for various eye-related expenses, including regular eye exams, prescription eyewear, and even surgeries. In this blog post, we’ll delve into the world of eye insurance, answering frequently asked questions to help you better understand this crucial aspect of healthcare.

What is Eye Insurance?

Eye insurance is a type of health insurance that covers a range of vision-related services and expenses. It is designed to reduce the financial burden of routine eye care, prescription eyewear, and eye surgeries. While not as comprehensive as regular health insurance, eye insurance can significantly lower your out-of-pocket costs for eye-related services.

What Does Eye Insurance Typically Cover?

Coverage varies by insurer and plan, but vision insurance typically covers the following:

  • Preventive and routine annual eye exams
  • Eyeglass frames and lenses
  • Contact lenses

Vision insurance may also provide some coverage, such as a discount, for elective procedures like LASIK. Each vision insurance plan has its own terms and coverages, so review the specifics when you compare options.

As soon as you purchase or enroll in a vision insurance plan, obtain a copy of your plan brochure or find out how to access it online. Study the brochure carefully to determine what your benefits include, what costs are involved, and who is on your network provider list.

Does insurance cover contacts and glasses?

Vision insurance typically does cover contacts and glasses. Adult health insurance alone often doesn’t cover corrective lenses unless the plan includes vision coverage. You might be able to find health plans that include vision and dental insurance for kids, particularly on the government Marketplace, since the Affordable Care Act considers them essential benefits for children.

A list of value-added eyewear products covered under vision benefits might include:

Ask your Family Focus Eyecare optician about the benefits of each of these products to get the most out of your vision insurance or benefits plan. Even if one of these items is not covered by your plan and you have to pay for it out-of-pocket, the other components of your glasses that are covered may result in a significant discount of the entire cost of your eyeglasses.

Do I Need Eye Insurance if I Already Have Health Insurance?

While your regular health insurance may cover some eye-related emergencies or medical conditions, it typically does not cover routine eye exams or the cost of eyeglasses or contact lenses. If you value your vision and want to reduce the costs associated with maintaining good eye health, having a separate eye insurance plan can be beneficial.

How Much Does Eye Insurance Cost?

The cost of eye insurance varies depending on several factors, including your location, the coverage level you choose, and the insurance provider. On average, you can expect to pay a monthly premium of anywhere from $10 to $25 for an individual plan. Family plans may cost more. Keep in mind that the higher the premium, the more comprehensive the coverage is likely to be.

Are There Waiting Periods for Eye Insurance?

Some eye insurance plans may have waiting periods for specific services or benefits. For instance, there might be a waiting period for certain surgical procedures or expensive eyewear. It’s essential to read the terms and conditions of your policy carefully to understand any waiting periods that may apply.

Can I Use My Eye Insurance Right Away?

In most cases, you can use your eye insurance as soon as your policy becomes effective. However, be aware that some insurance plans may have waiting periods, as mentioned earlier. If you have specific eye care needs, such as getting new eyeglasses, it’s advisable to confirm with your insurance provider when your coverage begins.

What can I Expect When I Make an Appointment with Family Focus Eyecare?

At the time of your appointment, you will be asked to show your vision insurance I.D. card or give some other proof of vision insurance coverage. Depending upon your vision plan, you also may be asked to pay a deductible, and/or a co-pay or discounted prices for the services you receive. Sometimes we need to obtain pre-authorization from your vision insurance company before performing your exam.

If you require prescription eyewear, your optometrist or ophthalmologist may also help you pick out eyeglasses or fit you with contact lenses if these services are available on site.

Can I Choose Any Eye Doctor with Eye Insurance?

Eye insurance plans often have a network of preferred providers, which may include optometrists, ophthalmologists, and eyewear retailers. While you can generally visit any eye doctor, you may receive maximum benefits and lower out-of-pocket costs when you choose a provider within your insurance network. Always check with your insurance provider for a list of in-network professionals.

Can I Get Eye Insurance as Part of My Employer’s Benefits Package?

Many employers offer eye insurance as part of their employee benefits package. If your employer provides this option, it can be a cost-effective way to obtain coverage for your eye care needs. Be sure to review your company’s benefits package to see if eye insurance is included.

Vision insurance is often separate from health insurance (also known as a standalone policy). They have their own premium and deductible and might cover more than any relevant coverage included in your overall medical plan because of the specialized care it covers. Additionally, glasses were historically made and sold by craftsmen — not doctors — leading to a long-standing distinction between health and vision care.

Do I need Eye Insurance for My Children? 

Within the first year, your baby should be screened three times to assess vision and eye development. During regular well-child visits, a pediatrician will perform the screening by shining a light in the child’s eyes to check pupillary reaction and eye alignment.

Your child will need an eye exam at age 6-12 months, age 3 and then every year thereafter. If your child has a family history of pediatric vision issues, or if you notice any strange or abnormal behavior with your child’s vision, you should contact your pediatrician. In some cases, more frequent eye exams may be required.

When we say family is our focus, we mean it. At Family Focus Eyecare we participate in the InfantSEE program, which offers free eye exams for infants aged 6 to 12 months. We also take part in the SEEtoLearn program, which offers free eye exams for 3-year-olds. 

Often, medical insurance provides free annual eye exams for children under 18. If you want to find out whether or not your insurance covers eye exams for you and your family, please get in touch with us. We can look up your provider and give you an answer right away.

Children’s Health Insurance Program (CHIP) is available for children who meet the standards set by each individual state. If your child is eligible for CHIP coverage, you will not have to purchase any additional insurance for them. CHIP will cover vision and dental care, emergency services, immunizations, routine check-ups and more.

A perk with CHIP is that you don’t have to wait for open enrollment — you can apply at any time to find out if your child meets the state requirements. 

Are There Discounts for Vision Care Services Without Eye Insurance?

If you don’t have eye insurance, there are still ways to save on vision care expenses. Some eye care providers offer discounts or membership programs that can help reduce the cost of eye exams, glasses, and contact lenses. Additionally, some nonprofit organizations and government programs provide assistance for low-income individuals and families.

How Do I Choose the Right Eye Insurance Plan?

Selecting the right eye insurance plan involves considering your specific needs, budget, and preferences. Start by comparing the coverage options and premiums offered by different providers. Pay attention to factors such as network availability and the list of covered services. Also, read reviews and ask for recommendations from friends or family members who have eye insurance. Ultimately, choose a plan that aligns with your eye care requirements and financial situation.

Pro Tip: Understand the difference between vision insurance versus vision discount plans

Insurers may distinguish between “vision discount” and “vision insurance” plans. Each covers similar types of services and products, but the way you pay is different.

  • Vision discount plans: A vision discount plan covers a percentage of your fees for a covered exam or corrective eyewear. It often costs less than vision insurance but may offer less coverage.
  • Vision insurance plans: Vision insurance plans work like a health insurance plan. You may have a deductible, copay, and/or co-insurance to pay when you visit the eye doctor, and your insurance pays for the remaining covered costs. When you buy covered eye care products, you may have an allowance from your insurer. You’ll be responsible for the difference if the cost of the product exceeds your allowance. It’s possible to have insurance pay the whole cost of a product like glasses, but discount plans will typically pay only a percentage of the cost.

Is vision insurance worth it?

Plans can be affordable, so if you have regular vision care costs, vision insurance might be worth it. Add up your average annual out-of-pocket costs for eye doctor visits, glasses, and contacts, and compare that with quotes for vision insurance. Remember to factor in the potential deductible, copays, and co-insurance when you compare plans. If you have good vision and don’t need regular eye care, vision insurance may not be worth it right now.

To decide whether or not you need vision insurance, you’ll have to answer some key questions. 

  • Are you willing to pay a monthly premium for long-term savings on eye exams and eyewear? 
  • What types of services and products would your plan cover? 
  • Will you shop for glasses or contacts often enough to get the most out of your benefits? 
  • How much does your insurance reimburse you for out-of-network services and purchases? 
  • Would an FSA (flexible spending account) or HSA (health savings account) be a better fit for your lifestyle?

What Insurance Plans Does Family Focus Eyecare Cover?

At Family Focus Eyecare, we work with a wide variety of insurance providers. If you don’t see your provider on this list, please call our office. Our friendly team is standing by to help.

Written by Family Focus Eyecare

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