Vision Insurance

Almost like a car, the eyes need regular care to ensure that they will continue functioning properly. And as with a car, getting care and maintenance for your eyes can cost a considerable amount of money. Vision insurance helps people with refractive errors — including those who are nearsighted, farsighted, or have astigmatism — reduce those expenses and plan for future eye care costs. Many people have questions as to how exactly vision insurance works, such as what it covers and which doctors can be visited once a plan is chosen. Read below to find some answers to these and other questions.

What is vision insurance?

Like dental insurance, vision insurance is a supplement to normal health insurance that covers routine care. Vision insurance plans reduce the cost of routine eye checkups and treatments and help pay for small portions of major eye care procedures. Most plans require the payment of a regular monthly premium and in return offer either reduced-price eye care services (discount vision plans) or coverage for a set number of services per year with only a small copay each visit (vision benefits packages). Either the patient or the employer providing the benefit may pay the premium. Depending on the vision insurance plan and provider, the patient may be restricted to using only certain, plan-affiliated eye care specialists.

How do I choose a vision insurance plan?

In many cases, your vision insurance choice will be determined by your employer; many companies contract for eye care plans and offer them to their employees at reduced premiums. If you are selecting from multiple options, though, several factors will determine which plan is best for you.

Discount Vision Plans vs. Vision Benefits Packages

First of all, you should decide whether a discount vision plan or a vision benefits package better fulfills your needs. The main difference between the two is that the benefits package leads to a lower cost for eye checkups and treatments but only pays for them a certain number of times per year. The amount the patient pays per service is usually between $10 and $15 under this type of vision insurance. Discount plans typically do not defray as much of the cost for each service, but patients may access them as often as they desire. Both types of plans sometimes include an annual deductible of up to $35 before they begin paying for treatments.

HMO Plans vs. PPO Plans

The second consideration for the vision insurance shopper is the type of service network available with each plan. An HMO plan will often provide the best discounts but will also require that the patient stay within its network of service providers in order to receive coverage. A PPO plan offers more choice: there is still a provider network, but patients may choose outside care providers and have their costs covered to a lesser extent.

Indemnity Health Insurance Plans

One less common option is an indemnity health insurance plan, which has no provider network at all, giving the policyholder free choice. In choosing your vision insurance plan, you need to consider how far you will need to travel to access a network provider and whether the cost of doing so is justified.

Vision Insurance Costs

Lastly, of course, the cost of vision insurance must be considered. Everyone naturally wants to pay the least amount possible, but a lower price often means a lower quality of service. Generally, the insurance premium is higher when more of the service cost is covered, more service provider options are available, more services are covered, and services may be accessed more often. Finding the right balance between these factors and the price of coverage depends on the needs and budget of the individual.

How do I choose a doctor under my vision insurance plan?

As discussed above, most vision insurance plans offer full coverage only within a network of service providers. PPO plans, unlike HMO plans, will cover some services performed outside of the network but will require that the patient pay more for those services. Whether you have a PPO or an HMO, your plan documentation should contain a list of in-network service providers in your area. With that list in hand, you can choose a doctor based on proximity, cost, and quality of service. Sometimes, especially in the case of major treatment like cataract surgery or LASIK, it may be worthwhile to go out of your vision insurance network, pay a little more money, and get the best service possible — rather than simply opting for the cheapest treatment available. Your primary care physician may be able to offer recommendations for certain service providers. In the end, though, you will have to decide what factors are most important to you in making your decision.

What services do most vision insurance plans cover?

Vision insurance usually covers all routine eye care procedures, but not major elective ones. Regular health insurance usually covers necessary treatment for major eye disorders such as glaucoma, macular degeneration, and diabetic retinopathy. Thus, vision insurance is best for people who need routine, regularly scheduled eye exams. Most plans cover these checkups and some of the cost of contact lenses and new eyeglasses, though often just a limited number of times per year.

Major procedures such as LASIK are not considered necessary for visual health and function, so most vision insurance plans do not cover them. Some plans do offer small discounts if a preferred specialist is chosen, but generally this does not amount to a large percentage of the procedure’s cost. Cataract surgery, on the other hand, is frequently covered by vision insurance, since this procedure is often necessary to prevent major loss of eyesight or even virtual blindness. Consult your plan documentation to learn which procedures are covered under your particular form of vision insurance.

Contact an Ophthalmologist in Your Area

We encourage you to seek the regular eye care you need for continued vision health today. If you would like to contact ophthalmologists in your area and find out whether your vision insurance plan will cover services at their offices, please take a moment to visit our directory of specialists by region.