How Does Vision Insurance Work?

Posted: January 10, 2024

Did you know that as many as 11 million Americans need vision correction? A vision insurance policy is essential to help maintain eye health and reduce eye care costs.

Unlike a regular health plan that only covers unexpected vision costs such as eye injury or disease, vision insurance helps you maintain eye wellness. It gives you access to routine eye exams, vision-related treatment and preventive care, depending on the insurer and plan.

Vision insurance remains a gray area for many Americans. Use this guide to learn about what it is, how it works and what you can expect it to cover.

Defining Vision Insurance

Vision insurance is a type of policy that covers specialized eye care. It’s separate from health insurance and covers eye care expenses as opposed to general eye health. It’s important to distinguish between vision discount and vision insurance — two types of plans that offer similar benefits and are often confusing. Here’s an overview:

Vision discount plans: Discount plans cost less than vision insurance and provide a predetermined discount on covered eye care expenses, such as eye exams and corrective eyewear.
Vision insurance plans: Vision insurance covers your eye care expenses on a full, copay or deductible basis. On a copayment basis, your vision insurance covers a fixed amount of covered expenses. When you have a deductible plan, you must pay a certain amount before your insurance steps in. You can determine whether copays or a deductible apply by reviewing your Summary of Benefits.

How Vision Insurance Works

Vision insurance works similarly to health insurance plans in that you can purchase it through your employer or from a carrier directly. You’ll then pay monthly or yearly premiums that cover specific eye care services to reduce your out-of-pocket expenses.

Premiums for vision insurance are significantly more affordable than health insurance premiums. With vision insurance, you can access a wide selection of services at discounted rates or with copayments, depending on the specific coverage of your plan.

A vision insurance plan may be offered as part of your health insurance benefits or as standalone coverage. Most plans work with in-network providers only, while some offer reimbursement for eye exams and products from out-of-network providers, including optometrists and ophthalmologists. Choosing in-network providers minimizes out-of-pocket expenses and maximizes your plan’s benefits.

Standalone vision insurance is only available to adults above the age of 18. Pediatric vision coverage is an Essential Health Benefit under the Affordable Care Act (ACA), meaning it’s part of the benefits on major medical insurance plans. In addition, you can include children in the family vision plan to maximize their eye care benefits.

What Does Vision Insurance Cover?

Your medical insurance covers general eye health, such as eye diseases and injuries treated by ophthalmologists. Your vision insurance covers claims not included in your medical plan. While these vary depending on your insurer and specific plan, some benefits are consistent among most vision insurance plans. These include:

Annual or biannual routine eye exams
Vision correction tools
Prescription eyeglass lenses
Prescription contact lenses
Lens enhancement

Routine eye exams are meant to monitor eye health, detect vision issues and determine prescription requirements. Most vision insurance plans offer flat copay rates for eye exams and lenses. The copay you get for lenses depends on the type of lens you need. You also receive a frame allowance that you can use to either pay for frames or contact lenses.

Some plans offer discounts on additional products such as blue light filters, digital surfacing, anti-reflective lenses, scratch resistance, extra pairs of glasses, reading glasses and luxury frames.

Vision insurance also covers refraction — an eye exam conducted when you need a new pair of contact lenses or an eyeglass prescription. This procedure is separate from your annual exam. Additionally, an insurance plan may provide you with some coverage or offer a discount for elective procedures such as laser vision correction with in-network providers.

What Vision Insurance Does Not Cover

Vision insurance plans do not cover many medical-related eye expenses. For example, if you’re getting your annual vision exam and a medical condition such as dry eye is discovered, your vision insurance will not cover the eye exam conducted to investigate the condition or prescribed medication.

Other standard exclusions among insurers and vision insurance plans include:

Vision loss
Floaters
Eye infections
Eye diseases
Allergies
Major medical treatments or eye surgery
Non-prescription contacts and glasses
Contact lens fittings for first-time wearers or patients looking to change the brand
Monitoring cataract development
Eye exam for patients diagnosed with diabetes
Eye exam for patients using medications with potential eye-related side effects
Eye exam for patients with macular degeneration or at high risk of glaucoma development

Fortunately, many medical-related costs regarding your eyes may be covered by your health insurance plan. It’s also a good idea to check with your insurer to confirm if there’s anything else they may not cover.

Frequently Asked Questions

Here are the most frequently asked questions related to vision insurance plans.

When should you get vision insurance?

The best time to get vision insurance depends on your financial situation and eye care needs. Vision insurance can help you save more in the long run by minimizing out-of-pocket expenses and giving you access to discounts on various services.

You should get a vision plan as soon as possible if you have a family history of eye conditions or any existing vision problems. Even without any known risks or predisposition to eye conditions, vision insurance will help you maintain your eye health and wellness.

Is vision insurance part of health insurance plans?

Vision insurance is typically offered as a standalone policy for adults, but some health plans include vision coverage as part of their benefits. Vision coverage for children is a mandatory inclusion on all major health insurance plans.

Can you use vision insurance and medical insurance simultaneously for the same service?

Insurance company policies do not allow billing your vision and medical insurance for the same service on the same day.

Apply for Vision Insurance Fast With Health for California

Are you looking for vision insurance, but have no idea where to start? Health for California is here to help you explore vision insurance options online. We provide California residents with an easy and fast application process that includes accurate quotes comparing various options on the market. Our agents are just a phone call away to answer any questions and guide you on how to choose the best vision insurance for you and your family.

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