If you wear glasses or contacts, you'll know there's a hefty price tag for keeping your vision clear. The average cost of frames and lenses alone is over $250. But a vision care plan can help make eye care more affordable.
You may get vision care coverage through your employer, or you may purchase it separately on your own.
Vision Care and the Affordable Care Act
Under the Affordable Care Act, insurance Marketplaces, also called Exchanges, were set up in each state. A Marketplace is a web site that lets you enroll in health plans.
The Affordable Care Act considers vision care for children to be an "essential benefit." This means that every plan sold in the Marketplaces must include vision care for children. But health insurance plans for adults that are sold in the Marketplaces do not have to include vision coverage.
What Types of Plans Are Available?
There are two general kinds of vision care coverage: vision benefits plans and discount vision plans.
Vision benefits plans. These are true insurance policies. You pay a monthly fee called a premium. You then get coverage for annual eye exams, frames and lenses, and other eye care needs. You usually have to pay a small fee, called a co-pay, each time you use one of these services.
"It's very important that consumers, of any age, get an annual comprehensive eye exam, and you should always choose a plan that has that as a basic benefit," says Julian Roberts, executive director of the National Association of Vision Plans. "That's not only to detect changes in your actual vision, but because a comprehensive eye exam can detect early signs of other systemic diseases, like diabetes."
Most plans are set up as a PPO. In this type of insurance, there is a network of eye doctors that you are allowed to use. If you go "out of network" for your vision care, you pay a higher percentage of the cost yourself.
"Most plans will give you something of an allowance when it comes to materials," says Roberts. "They may pay up to $175 for frames, for example, and if the frames you want cost more than that, you'll have to pay the additional cost yourself."
Vision plans do not generally cover LASIK eye surgery or cosmetic services, although some do offer a discount on these options.
Discount vision plans. The fee for a discount vision plan is much lower than the monthly premium you'll pay for a vision benefit plan. The discount plans typically cover the same types of exams, lenses, and other products as vision benefits plans do. But they only give you a discount on these items -- usually between 15% and 35% -- rather than the more extensive coverage of costs in a vision benefits plan.
What Kind of Coverage Is Right for You?
To decide what kind of vision coverage you need, start by calculating how much you've spent on vision care over the past few years.
"If you have generally good eye health in your family and you don't spend much on eye care each year, you might consider a discount plan," Roberts says.
If you're spending more than a couple of hundred dollars a year on eye care, it's probably worthwhile to consider a vision benefits plan.
Questions you should ask yourself as you make a decision include:
- Is my eye doctor in the plan's network? If you don't have an eye doctor at the moment, is there an in-network provider within a reasonable distance from you?
- Do you need prior approval to go out of the plan's network for vision care? How much do you get reimbursed for out-of-network services?
- What are the monthly premiums for the plan?
- What are the co-pays required? Some plans may have lower monthly premiums, but higher co-pays.
- What deductible do I have to pay before coverage kicks in?
- What is the plan's frame allowance? If you have a preference for a more expensive style of frames, it might be worth it to spend more on a plan that has a higher level of coverage for frames.
"There are many more options for vision care plans now than there have been in the past," Roberts says. "As you're choosing a plan, remember that what is most important is for everyone to get a regular, comprehensive eye exam."
The American Optometric Association recommends that children get eye exams at age 6 months, age 3 years, before first grade, and every 2 years after that. Adults should get a comprehensive exam every 2 years until age 60. After 60, exams should be done every year. People at high risk for vision problems (such as children who were born prematurely, or people with diabetes) should get eye exams more often.