Vision insurance can seem like a confusing aspect of healthcare, but understanding what vision insurance covers — and what it doesn’t cover — can help you make informed decisions about your eye care. In this article, we’ll break down the basics of vision insurance, what services and products it typically covers, and what you might need to pay for out of pocket.
What Is Vision Insurance?
Vision insurance is a type of health insurance designed to reduce the costs of eye care. Unlike regular health insurance or Medicare, both of which cover a broad range of medical services, vision insurance focuses specifically on eye-related care. It can help cover the cost of routine eye exams, glasses, contact lenses, and sometimes even vision-corrective surgery. Vision insurance plans can vary widely in terms of coverage and cost, so it’s important to understand the specifics of your plan.
What Services and Products Does Vision Insurance Cover?
Vision insurance typically covers a range of basic vision services and products essential for maintaining eye health. Here are some of the common vision benefits and services that most vision insurance plans cover.
Preventive Eye Exams
One of the primary benefits of vision insurance is coverage for preventive eye exams. Regularly scheduled eye exams are essential for maintaining good eye health and can help detect issues like glaucoma, cataracts, and macular degeneration early on. Regular eye exams can also reveal signs of other health problems such as diabetes and high blood pressure. Vision insurance may cover the cost of a comprehensive eye exam once a year, although some plans may offer eye exams every two years.
Prescription Eyewear and Contact Lenses
Most vision insurance plans provide coverage or cost-reductions for prescription eyewear, including glasses and contact lenses. Typically, coverage includes:
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Frames: Vision insurance may cover a portion of the cost of eyeglass frames, often up to a certain dollar amount. If you choose frames that cost more than the allowance, you will need to pay the difference out of pocket.
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Lenses: Standard lenses for eyeglasses are usually covered, but there may be additional costs for certain types of lenses, such as progressive lenses or high-index lenses for stronger prescriptions.
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Contact Lenses: Vision insurance often covers the cost of contact lenses, either as an alternative to glasses or in addition to them. This can include the cost of fitting and follow-up visits related to contact lenses.
Glasses Lens Coating and Enhancements
In addition to basic lenses, vision insurance may cover various lens coatings and enhancements that can improve the functionality and comfort of your glasses. Some common lens enhancements include:
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Anti-Glare Coating: This lens coating reduces glares and reflections, making it easier to see in bright light conditions and when using digital devices.
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Scratch-Resistant Coating: This lens coating helps to protect your lenses from everyday wear and tear, prolonging their lifespan.
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UV Protection: Lenses with UV protection help shield your eyes from harmful ultraviolet rays, reducing the risk of eye damage and related conditions.
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Photochromic Lenses: These lenses darken in response to sunlight, functioning as both regular glasses and sunglasses.
Vision Correction Surgery
Some vision insurance plans may offer coverage for vision correction surgeries such as LASIK. Surgery like LASIK can correct common vision problems like nearsightedness, farsightedness, and astigmatism, potentially eliminating the need for glasses or contact lenses. However, vision insurance coverage for LASIK and other vision correction surgeries varies significantly between plans. Some may cover a portion of the cost, offer a discount, or exclude it entirely.
What Vision Insurance Does Not Cover
While vision insurance covers many essential eye care services, there are some things it typically doesn’t cover. Here are a few items you may need to pay for out of pocket:
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Non-Prescription Eyewear: Most vision insurance plans do not cover non-prescription sunglasses or glasses used purely for fashion.
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Cosmetic Procedures: Procedures purely for cosmetic purposes, such as eyelid surgery or other aesthetic enhancements, are usually not covered.
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Medical Treatments for Eye Diseases: Vision insurance generally does not cover medical treatments for eye diseases like glaucoma, macular degeneration, or diabetic retinopathy. These treatments are typically covered under regular health insurance plans.
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Specialty Lenses: Specialty lenses, such as those for specific sports or occupational needs, may not be covered under standard vision insurance plans.
Conclusion
Vision insurance is valuable for managing the cost of routine eye care and maintaining good eye health. Vision plans typically cover preventive eye exams, prescription eyewear, and certain lens enhancements — services and products not typically offered by Medicare or health insurance plans. Some plans may also offer coverage for vision correction surgery like LASIK.
It's important to be aware of the limitations and exclusions of your vision insurance plan, as not all services and products are covered. By understanding what vision insurance covers and doesn't cover, you can make informed decisions about your eye care and compare benefits, helping you choose the best plan for you.
Regular eye exams and proper eyewear are essential for maintaining good vision and overall health. With the right vision insurance plan that makes it simple to find an eye doctor near you, you can receive the necessary care without breaking the bank.
Information received through VSP Individual Vision Plans’ social media channels is for informational purposes only and does not constitute medical advice, medical recommendations, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Reviewed by Dr. Valerie Sheety-Pilon:
Dr. Valerie Sheety-Pilon is Vice President of Clinical and Medical Affairs at VSP Vison Care where she helps drive strategic initiatives aimed at raising awareness about vision, eye health and its connection to overall wellness, while providing insight into medical advancements that seek to benefit patient care. She also provides oversight of VSP programs to address gaps in care for some of the most high-risk populations, including those living with diabetes.
With more than two decades of experience as a Doctor of Optometry, Dr. Sheety-Pilon has dedicated much of her time to clinical research across numerous ophthalmic subspecialties and has an established history of helping patients through novel therapeutic agents and clinical adoption of transformative technology in the areas of digital health, pharmaceuticals, and medical devices.
Prior to joining VSP Vision in 2019, Dr. Sheety-Pilon served as Adjunct Clinical Professor at Illinois College of Optometry, held various executive positions within the eye health industry, and has extensive experience managing and practicing within an ophthalmology and optometry practice.
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