If you have a health insurance plan, it’s possible that you don’t automatically have vision benefits. Here’s what to know about getting them.

Let’s say you just got some new health insurance benefits. You’re probably saying to yourself: “Woo-hoo! Now I can get every part of my body checked.” But that’s not always the case.

Simply having health insurance doesn’t always mean you’ll be covered if you go to the eye doctor and get your eyes checked. Often, you need a separate type of insurance for that.

“Vision insurance provides coverage for expenses related to the correction of vision issues,” explains Jenny Chumbley Hogue, an analyst for healthinsurance.org. It’s designed to help you cover and budget for ongoing vision care expenses such as routine eye exams, prescription glasses and contact lenses. You can buy vision plans in addition to your health insurance, or even pair them with other supplemental plans, such as a dental plan.

Here are some of your biggest vision insurance questions, answered.

Need a vision plan? Explore your options now, or contact a licensed agent at 1-844-211-7730.

Why do I need vision insurance?

All Affordable Care Act and qualified health insurance plans must include vision coverage for children, but they don’t necessarily cover it for adults.

“Medical insurance covers health coverage for your eyes — so if you develop a certain disease or condition, like eye cancer, a detached retina or a cataract, your medical insurance will step in,” says Todd Ackerman, president and Iowa unit leader of World Insurance Associates in Burlington, Iowa.

But your health insurance plan won’t cover routine vision expenses, such as an exam to measure your eyesight for glasses or the cost of eyeglasses or contact lenses. That’s where vision insurance can step in and fill the gaps, says Chumbley Hogue.

While most vision plans don’t fully cover corrective eye procedures such as LASIK, “they often offer discounts on the surgery itself,” adds Ackerman.

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What do I need to think about when shopping for a vision plan?

So, you’ve made up your mind: You’re going to buy vision insurance. But there are so many options out there. Here are some things to keep in mind:

• Is the eye doctor you want to go to covered under this plan? “There are some plans that only cover eye exams at big-box stores like Target,” says Ackerman. If you already have an eye doctor that you’re positive you want to go to, you may need to do a bit more legwork to find the right plan.
• What are the deductible and copayment? The deductible is what you pay before your insurance company pays the rest. For example, if your deductible is $1,000, you’ll have to pay that amount out of pocket before your insurance kicks in. And a copay is a fixed amount you pay for a service. So, maybe you’d pay a $40 copay to see a certain eye doctor, for example.
• What extra benefits does the plan cover? Most vision plans provide a yearly allowance to cover certain vision costs and/or glasses, including frames and lenses. “You’ll want to find out if they cover any enhancements, such as scratch-resistance services, and how often you can get replacement frames and lenses,” explains Ackerman.
• What’s the waiting period for benefits? If there’s a waiting period before your benefits kick in, that could mean you’ll have to pay for certain services entirely out of your own pocket until your coverage becomes effective.

Looking for routine eye exam coverage? Need prescription eyewear? Learn more now, or call a licensed agent at 1-844-211-7730 to discuss a vision plan.

What are the benefits of pairing up my vision plan with another supplemental plan?

As you’ve already learned, you’ll likely have to buy a vision plan separately from your health plan. You can do this in 2 ways:

1. Buy a stand-alone vision insurance plan. These plans often have more flexibility, as you can choose a plan that covers glasses, contacts or both.
2. Buy a plan that pairs vision benefits with another type of supplemental coverage, such as dental insurance. “Oftentimes, you can buy a plan that offers vision care, dental care and hearing aids,” says Chumbley Hogue. These plans generally include vision care plan benefits such as routine eye exams, an allowance for prescription glasses and contacts, and discounts on other vision services. But each plan has different benefits and rules, she adds, which is why it’s important to review them carefully and understand how the bundled coverage elements work together.

You’ll want to make sure to ask whether the plan has a maximum dollar amount for everything included, and whether there’s a waiting period.

Even if you need just one of the coverage elements — for example, vision care — it may be a good idea to pair plans. That’s because your monthly insurance bill (premium) may be a similar cost to what you’d get if you purchased a stand-alone plan. “In that case, having the extra coverage may not be a bad choice,” explains Chumbley Hogue.

Some insurance companies, such as UnitedHealthcare, offer both stand-alone plans and paired plans, aka a vision rider (you add vision care to a dental plan for an additional monthly bill). Both types of plans allow you to pick your eye doctor and prescription eyewear. Benefits can include:

• Coverage for eyeglass lenses and frames, contact lenses or both.
• Provider choice. UnitedHealthcare, for instance, has a large national network of private doctors and retail stores you can choose from.
• The ability to go out of network. Out-of-network providers are covered, but without network discounts (you pay any charge above the allowance for non-network providers).
• No waiting periods.
• Coverage for all ages.

Got questions about vision insurance? Take a glance at the benefits and compare with confidence, or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

Source:
Healthcare.gov. “Vision coverage.” Accessed August 11, 2023.

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