Many vision insurance plans provide reimbursements for new frames, lenses and contact lenses purchased with your plan – however these vary according to each individual plan.
Individual vision plans can be purchased separately from vision providers or added to your flexible spending account (FSA) or health savings account (HSA). Before choosing one of these plans, evaluate its network coverage and cost sharing responsibilities to see if this coverage suits your needs.
What’s Covered?
Opposite of health insurance plans that offer general medical coverage and emergency assistance, vision insurance focuses exclusively on eye exams, eyewear and contact lenses. While vision plans tend to operate separately from health plans in terms of premium payments, bundle policies together in order to save on annual premium costs.
Vision insurance policies vary greatly by provider and plan. Some provide PPOs (Preferred Provider Organizations) or HMOs (Health Maintenance Organizations), which set aside certain providers as Preferred. You have the freedom of choosing in-network or out-of-network providers; generally however, using in-network ones tends to cost less.
Most plans cover the costs associated with routine eye exams, and, depending on your policy, a specific allowance for frames and lenses. However, it’s essential that you fully understand your coverage prior to visiting a vision center to avoid unexpected surprises – for instance, your plan might only cover basic frames but not higher-end brands or it might cover part of the lens price but require you to pay the remaining balance out-of-pocket.
Your vision plan may also cover additional services, including glaucoma tests and evaluation of symptoms such as dry eyes, allergies or eye diseases. Some plans offer specialty lenses with anti-reflective coating or scratch resistance capabilities.
Vision insurance may also cover expenses associated with contact lens solutions and surgeries, which are typically out-of-pocket expenses, but it can help offset some of their high costs.
Many major medical insurance policies now provide vision coverage as part of a child’s deductible or copays, while adults can purchase standalone vision coverage or be included on their spouse’s health plan.
Discount plans work similarly to vision insurance and can be obtained both individually or through employers. Instead of paying monthly premiums, these discount plans reimburse you once your annual limit has been reached for eye care expenses. Although not true insurance plans, discount plans may provide an affordable solution if traditional health or vision policies don’t fit your needs or want or need tax deductible expenses before making your decision.
Getting Started
Vision coverage can be obtained in several different ways. Individual plans or employee health plans with vision benefits packages offer these coverage options, while vision-only supplemental insurance policies often offer cheaper coverage that focuses on regular eye exams or buying glasses when necessary.
Some plans cover both frames and lenses while others only pay an allowance towards new glasses. When making your decision on which type of plan to purchase, it’s essential that you assess both your current and projected optical needs so as to maximize savings.
Opting for in-network providers is an essential component of controlling costs. Providers who participate in vision insurance networks have agreements with insurance companies that enable them to offer discounted services at a discounted rate for plan members – making in-network providers an effective way of saving money without compromising quality care.
Beginning your vision coverage can be relatively easy. Most insurers offer online tools that enable you to estimate costs and coverage before committing to one plan, and allow comparison between multiple insurance providers for best value for your budget. In addition, customer service representatives from most insurance providers are readily available to answer questions about buying vision insurance plans and assist in purchasing them.
If you’re in search of an all-encompassing vision insurance plan that covers everything from eye exams to laser vision correction, Preferred Provider Organization (PPO) plans may offer more coverage. While these policies do have limited networks of participating providers, they typically provide the highest coverage levels for routine eye care services and products. It is also worth keeping in mind that many employers only provide PPO plans through their group health plan during open enrollment periods which usually happen around October/November.
Copays and Deductibles
Vision insurance may not cover unexpected expenses like medical insurance does, but it can still help cover anticipated ones like eye exams and new lenses. To decide if paying for vision coverage is worthwhile, take into account both its annual cost of premium plus any associated copays as well as how much money would otherwise be spent on those expenses without it.
Many employers include vision coverage as part of an overall benefits package or as a stand-in option, while individual plans can also be purchased online. Depending on your specific needs, bundle plans offering both vision and dental coverage could save money in cost.
As you compare vision insurance options, make sure to evaluate each plan’s coverage of each service or material you may require – for instance, VSP Individual Vision Plans include an eye exam and two pairs of glasses or contacts while others offer more extensive lens allowance with more options.
Another key factor in selecting your plan is whether it contains a deductible or copay. Deductibles are fixed amounts you must pay before your insurance coverage takes effect, while copays represent agreed-upon portions of services you pay at time of appointment – some plans offer pre-deductible and post-deductible copays depending on what service type it covers, so be sure you know its rules before signing on!
Paying for vision care requires understanding that most plans only cover certain services from providers in their provider network. When enrolling, most insurers offer lists of preferred providers who may offer in-network care; out-of-network plans usually incur higher out-of-pocket expenses and offer limited coverage limits.
Exclusions
As with any type of insurance policy, vision plans typically exclude certain things – some more obvious than others, like elective and cosmetic surgery like LASIK surgery; but also including eye exams, glasses and contact lenses typically covered. Your vision insurance also won’t cover accidents involving your eyes as this would generally fall under regular health coverage’s domain.
Many employees opt to utilize their flexible spending account (FSA) or health savings account (HSA), which allows them to set aside pre-tax dollars for medical expenses including vision care. By spending these pre-tax dollars for an annual eye exam, frames, lenses or sunglasses you can maximize yearly benefits while helping reduce overall healthcare costs. It is important to remember that FSA and HSA accounts do not carry over into subsequent years so it is wise to use your FSA/HSA dollars wisely!
