What Does Vision Insurance Cover?

Posted: April 10, 2024

Vision insurance is a plan that covers specialized eye care, such as routine eye exams and prescriptions for correcting vision errors, subject to exceptions. It’s separate from your medical or health insurance, covering eye care expenses instead of general eye complications considered as medical issues. The specific coverage under vision insurance varies depending on the insurance provider and the terms of the insurance contract or policy. However, there are some standard inclusions. It’s important to review your plan to determine what it covers and the level of coverage it provides.

This guide discusses the standard vision insurance inclusion and exclusions. It also addresses the coverage you need if your vision insurance does not cover a condition or treatment.

Five Items Vision Insurance Covers

Vision insurance coverage depends on the insurer and the plan you purchase. However, standard coverage includes:

1. Routine eye examinations, whether annual or biannual
2. Vision correction tools
3. Prescription contact lenses
4. Prescription eyeglasses
5. Lens enhancement

Does Insurance Cover Contacts?

You may get contact coverage on your medical or health insurance plan as an extra package. If your plan excludes contacts, vision insurance can provide coverage. Generally, getting contact coverage on your vision insurance plan is easier when it’s medically required than when it’s elective.

Contacts are medically required when an eye specialist prescribes them to correct vision errors that glasses cannot fix. Examples include diseases affecting the eye’s surface or irregularly shaped cornea. Your prescription may be considered elective if your vision can be corrected with eyeglasses.

Some vision insurance plans provide a set annual amount for contact lenses. The amounts vary, but comprehensive coverage with higher premiums usually has higher allowances. Other plans also provide discounts for contact lenses. This happens when the provider partners with optical retailers and eye care affiliates to offer special promotions to customers. It’s essential to review your insurance contract to know the details.

Does Insurance Cover Glasses?

Most medical or health insurance exclude glasses. If your current plan excludes eyeglasses and lenses, the best option would be to get vision insurance coverage. Vision insurance covers prescription eyeglass lenses, with most offering a flat copay rate.

The copay for lenses typically depends on the type of lens. You may also receive an allowance, which you can use to pay for contact lenses or glasses. Other coverages provide discounts on additional products, such as the following:

1. Digital surfacing
2. Blue light filters
3. Anti-reflective lenses
4. Reading glasses
5. Scratch resistance lenses
6. Extra pairs of glasses
7. Luxury frames

It’s essential to remember that vision insurance often excludes non-prescription glasses.

Does Health Insurance Cover Eye Exams?

Some medical or life insurance plans include eye exams, but you may need vision insurance for routine checks. Vision insurance may also cover special checks like refraction, which is conducted when you need a new pair of eyeglasses or contact lens prescription. The plan may also provide coverage or discounts for elective procedures like laser vision correction with in-network providers.

Does Vision Insurance Cover Dry Eye Treatment?

Vision insurance typically excludes dry eye treatment, but you may be covered under your medical insurance. This is because dry eye is considered an eye disease, which makes it a medical issue. Medical insurance covers most eye-related complications and routine eye exams caused by diabetes. Examples include the following:

1. Floaters
2. Vision loss
3. Eye disease
4. Eye infections
5. Allergies

The coverage may differ depending on your insurance plans, so reviewing your policy is vital.

Does Vision Insurance Cover Sunglasses?

Most vision insurance plans provide coverage for prescription sunglasses. The plan usually provides annual lens and frame allowances to cover part or all of the costs, depending on the price. Therefore, you must pay the difference if your prescription sunglasses cost more than the allowance.

You can use your vision insurance to pay if you order prescription glasses from a store in your network, subject to the terms of your policy. If your policy covers such transactions, you may need to file a claim if you go outside your network. Other plans offer discounts for non-prescription glasses if you buy them within your network.

Prescription sunglasses can correct your vision and provide shade. Those with ultraviolet (UV) shielding can protect your eyes from the effects of UV radiation. This is essential because prolonged exposure can cause complications.

What Does Vision Insurance Not Cover?

Vision insurance usually excludes medical-related eye expenses. Those expenses are typically covered under your medical insurance. Below are some examples:

1. Eye diseases
2. Eye infections
3. Vision loss
4. Floaters
5. Allergies
6. Non-prescription glasses or contact lenses
7. Patients looking to change frame brands or contact lens fitting for first-time wearers
8. Eye examination involving patients diagnosed with diabetes
9. Eye examination involving patients with macular degeneration or at risk of glaucoma development
10. Eye examination involving patients using medications with potential eye-related side effects
11. Monitoring cataract development
12. Eye surgery or major medical treatment

How Much Do Glasses Cost Without Insurance?

The cost of glasses without insurance varies depending on several factors, including the following:

• Eye exams: You must undergo an eye examination to receive prescription glasses. The price may vary depending on the medical facility and the professional involved. The three levels of eye care professionals who may be involved in the process are opticians, optometrists and ophthalmologists.
• Lenses: The costs of lenses depend on the level of vision correction and additional features you may want to include, such as transitional and blue light-blocking lenses. The lens quality also impacts the price. Single-vision lenses typically cost less than progressive lenses and bifocals.
• Frames: The cost of frames depends on the design and quality. You may purchase discounted frames at big box store retailers or choose a mid-range option, which will cost more. Designer frames are high-end products that you can buy at most optical centers.

Vision insurance helps you pay for routine eye examinations and eyeglasses, saving you money in the long term.

Need Help? Contact Health for California Insurance Center

Vision insurance covers specialized eye care, including routine eye examinations and prescriptions for correcting vision errors. This coverage allows you to get regular eye health check-ups and covers costs or reduces expenses for eye examinations and prescription eyewear. Some plans also let you save money on procedures like LASIK surgery.

Health for California Insurance Center can help you get vision insurance coverage that suits your needs. We have served clients for over 20 years, making health insurance simple and accessible to all. Our team of professional agents knows the industry and performs their duties with respect and kindness.

Partnering with Health for California Insurance Center gives you free access to our agents, who are always available to help and answer your questions. To learn more about our offerings, contact us now!