by Kaitlyn Ranze
If you wear glasses or contact lenses, you may be asking yourself whether vision insurance is worth it when looking at your open enrollment paperwork. Not to worry.
We break down the pros and cons of vision insurance, including what it might save you, how it costs you, and how to assess whether or not it’s right for you.
In short, vision insurance is a type of coverage that many people take out during open enrollment in order to help cover the costs of their eye care needs. Because vision care and vision insurance can be expensive, it’s important to understand the costs.
Vision insurance supplements one area your medical insurance may not cover: your vision.
Because your medical insurance may not cover routine eye exams, it’s important to first familiarize yourself with how your health insurance company handles routine eye exams versus medical eye exams. Why start with your health insurance?
Your medical insurance may pay for a routine eye exam.
If this is the case, paying for a vision insurance may be redundant. Why pay for extra coverage when your health insurance will cover your routine exam? Unless of course, you need new eyeglasses. Most medical insurances do not cover eye glasses or contact lenses. This is where the value of vision insurance may kick in.
Having vision insurance is a great way to save money on all sorts of eye care, but it’s important that you do some digging before blindly signing up for the cheapest provider that offers what you want. Not every company will cover everything you need and each may have different rules about what they’ll accept.
Your vision insurance may cover your glasses and contact lenses, but not treatment of a medical condition (think pink eye or chronic tearing). Also, a lot of medical insurance plans do not cover the prescription that doctors write to correct your vision (your glasses prescription).
Ok, we know. It’s getting a little bit complicated. When it comes time for a regular check-up to ensure that you’re seeing things clearly, you may find yourself wondering whether or not buying vision insurance is the right decision financially.
For many young adults, the eye doctor is the only doctor they see on a regular basis.
Real world example: You have sandy, grainy eyes that blur after staring at a computer all day so you see an eye doctor.
When you see an ophthalmologist for a sandy sensation, they will treat you under your medical insurance for a medical condition. They may also charge an additional fee if you request an eyeglass prescription at that time.
If you see an optometrist to check your vision, after an ophthalmologist has treated your eyes for the sandiness, your vision insurance will cover your routine exam.
Why does this happen?
And what does vision insurance ACTUALLY cover?
Insurance is actually a contract of benefits. This contract requires your insurance company to pay some or all of your costs in exchange for a premium. Your plans vary but here are few essential components of your plan.
The first thing to think about are these basics:
- Deductible – A deductible is the amount you pay for a service before the insurance company begins paying. For instance, you could have a one time deductible of $100 before the vision insurance pays for any contact lenses. The combination of a deductible + your monthly premium could mean that your vision insurance isn’t worth it.
- Co-Payment – A copayment is a fixed amount you pay for a service. Your eue exam could be covered by a co-payment but then any glasses are or lenses you order could be subject to a deductible. The good: Your insurance plan is covering most of the cost of your visits. The bad news: the combination of a copayment + your monthly premium could mean that your vision insurance isn’t worth it.
- Premium – the monthly fee for the contract of benefits, typically deducted from your paycheck.
- Limitations – your health insurance and vision insurance can put limitations on what treatments, procedures, and benefits you receive.
Your vision insurance strictly treats your vision. We’re talking about near-sightedness, far-sightedness and astigmatism. Dry eyes, pink eyes, droopy eyes: those are all medical conditions. There is a good chance your provider may need to bill your medical insurance to treat those conditions. These are part of the vision insurance limitations. And this is only the beginning.
The Cost of Eye Exams versus the Cost of Glasses and Contact Lenses
The eye exam itself is treated as a separate service from a fitting or prescription. This means you could be facing separate fees with or without the vision insurance.
How does this happen?
Your eyeglasses, contact lenses, and any procedures to treat the refraction (the eyeglass prescription) you receive are considered separate from the exam. This is all laid out in the contract of benefits you enroll in the insurance. Typically, a vision insurance will include this as part of your routine exam.
What makes up a good vision insurance plan
A good plan should allow you to get one full exam during its term and then continue with no additional fees through your next annual renewal date for another full, unrestricted exam the following year.
Vision insurance limitations
Many plans require or limit you to one eye exam per 12 month period. Even if you aren’t going for regular checkups yet but expect to in the future, buying vision insurance now may not be beneficial unless there is some flexibility on how soon it must be used. Additionally, this means that if your eyes change and your prescription changes, you may have to wait until your vision insurance is up for renewal before getting another exam.
Some vision insurance plans charge separate deductibles and copayments depending on the type of services you receive.
Your plan could look something like this.:
Monthly premium: $10
Deductible: 0
Out of pocket maximum: $500
Co-insurance: 70%.
Let’s say you get your vision insurance plan with no deductible. The total vision cost for your exam is $200, which you pay up front. Insurance will cover the rest of the cost — but if it comes out to $180, you paid your deductiblee amount even before vision insurance came into play! And once vision insurance does kick in, they’ll cover just 70% of whatever additional service or product you choose (the other 30% coming straight out of your pocket) until your yearly vision benefits max out at $500.
Many vision plans tout savings because there’s no deductible before they kick in . That sounds good until you realize two things: First, the total cost of your vision services might still come out to a deductible amount. Second, vision insurance may only cover a portion of vision costs after you’ve paid that deductible. Third, your premiums for the year could cost you more than if you’d shopped around and paid out of pocket.
The Annual Maximum Covers Less Than You Think and Come with Limitations
Not only are you limited with the number of exams you can have in a year, there may be other limitations of coverage in your vision plan. For instance, the vision benefits may max out, typically capped at $500. This means that if your desired frames cost more than $500, you may have to pay out of pocket. Similarly, your vision insurance may not cover premium lens types like transitions or unlined bi-focal. Also, plan members often find they have vision services which are “not covered”. This means that popular vision services, like vision corrective surgery or Lasik, might not even count toward your vision insurance max.
In network and out of network benefits with vision insurance
As for vision insurance’s disadvantages, vision insurers typically only cover treatments on an in-network basis. What does this mean? If you go to an out-of-network doctor, then there is no guarantee that an optometrist will accept your vision insurer’s plan (and the same goes for other vision providers like contact lens retailers and eyewear manufacturers). This will leave you footing the bill.
Also, some insurance providers only allow vision benefits during normal business hours at certain doctors’ offices. If your preferred eye clinic operates outside of typical work hours or is located outside of a major city, then purchasing vision insurance could prove useless. What’s worse is that many times these limitations aren’t made clear until you go to make a claim after having an eye exam.
So what are some benefits that vision insurance can offer and how can vision insurance save you money?
Glasses and Contacts Can Be Covered in Full
Vision insurance plans usually cover vision treatments in full. This includes the cost of prescription glasses and contact lenses when ordered during an eye exam covered by vision insurance. Depending on your vision insurer or what you already know about vision care costs (i.e., prices vary by provider), this is good news for your wallet.
With vision insurance you can get sunglasses and prescription glasses at discounted rates
If not covered in full by your plan, a lot of vision insurances offer special discounts on glasses and sunglasses. This means that some vision insurers will cover the cost of prescription glasses or sunglasses during your vision treatment — albeit at discounted rates. However, prices vary by provider, so it’s best to ask about eyeglass discounts before purchasing sunglasses or prescription glasses out-of-pocket with savings in mind (i.e., you shouldn’t go into debt just to get vision insurance coverage).
So while purchasing vision insurance seems like an easy way to get great deals on all sorts of eyewear, it’s important that you do your homework before signing up. Not every provider has exactly what you want in terms of coverage and there may be hidden fees or other caveats that make it better to shop somewhere else more suited to your needs.
There are ways to save on eyecare with and without vision insurance
Another benefit that good vision insurance plans offer is the ability to buy contacts without a prescription from an optometrist. This is often called “over-the-counter” or OTC purchases, meaning that you can buy them directly from the manufacturer with no need to go through any medical professional whatsoever. Going this route without vision insurance will surely save you over commercial retail pricing. (We’re talking about the retail chains that sell at shopping malls). A good vision insurance can help you save more by covering a greater portion of your costs.
While buying contacts in this manner can seem appealing, it does have some caveats. For example, while technically you don’t need to get your eyes checked before making an OTC purchase, many people find it difficult to find the right fit.
Additionally, while most manufacturers claim that finding lenses can be as simple as buying them from a local grocery store or pharmacy, that just isn’t true for most people who need more than readers.
Also, the FDA mandates that all contact lens wearers have a valid prescription . Even if you bought lenses without going through a professional, they still must meet very specific criteria. It’s unlikely that any OTC purchases would yield comfortable lenses at all.
Online optical
Another good benefit of vision insurance plans is being able to purchase glasses online directly from optical stores. In this case, you’ll get glasses delivered to your home for free or included in the price. This can help save time by avoiding shopping for new glass frames every time your prescription changes along with getting multiple pairs for different purposes such as driving, reading and working on a computer.
These options are notoriously low-cost but not limited to working with vision insurance providers.
If you can find a cost-effective eye exam at a self-pay rate, you may be better off avoiding vision insurance premiums, doing a little research, and ordering your updated prescription online through the likes of Zennioptical or EyeBuyDirect.
Queen of making a little go a long way, Mackenzie Stewart, from Life at 23k says “I absolutely love [Zenni] and they’re my go to for glasses. Even if you just buy their frames and use your insurance lens credit at an optometrist, it still saves you hundreds of dollars. It’s especially economical if you want prescription glasses and sunglasses or have kids that tend to lose or break their glasses. 12/10 would recommend.”
The downfall of online optical retailers
However, some online glasses stores aren’t created equal. For example, some may offer too few sizes or styles of frames to make shopping easy. Also, they might not be able to fit your lenses into standard prescriptions but rather require that you buy them under the manufacturer’s own guidelines.
Another downside is that with online purchases, there’s no way for you to try on glasses before buying them. Despite advances in “3D try-ons”, you won’t know if they properly fit your face until they arrive at your doorstep. This means it takes extra time and patience to find the right site with the best prices.
Another downside is that if your prescription changes, you need to buy new glasses which can be costly. This means another trip back to the store and more money out of pocket.
You Can Use Your FSA Account for Vision Coverage
There are some vision insurers that will allow their members to use Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) for vision insurance premiums.
You Can Bundle Your Vision Insurance Plan with Other Types of Insurance Plans
Usually, vision insurance is sold as a stand plan, but a lot of vision insurers will allow their members to bundle vision insurance with other types of insurance plans (e.g., dental, wellness) for additional discounts on premiums and reduce out-of-pocket costs. So, if you’re looking for ways to save money on vision care (and/or any other type of health or medical expense), then it would be wise to check out what vision insurers you can bundle your vision insurance plan with to save the most amount of money.
Should you enroll in your company’s vision insurance.
The short answer is that it depends.
To decide whether or not vision insurance is right for you, yourself these questions:
- Do you really need the coverage?
- Is your doctor in the network?
- Do you get a comprehensive eye exam? And what are the costs of comprehensive exams without coverage?
- How difficult or inconvenient is it to use the benefits?
- What’s the frame allowance or benefit maximum?
A lot of vision insurers will cover vision treatments at discounted rates or full costs, but it is important to note that not all vision plans are the same. Choose an insurer that fits your needs best. Also, keep in mind that some vision providers may require you to pay for follow-up vision care even if the initial vision exam was valued under a vision plan — so ask about this before using any type of vision benefit program (i.e., alone vision insurance or with another type of vision provider coverage).
Related Reads:
Taking Advantage of Open Enrollment
Seven Easy Steps for Open Enrollment
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