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. (There is a monthly premium for supplemental insurance that is not included in what you’d pay for your primary health insurance.)
Here are some of your biggest vision insurance questions, answered.
Don’t let cost get in the way of healthy eyes. Explore a vision insurance plan now.
Why do I need vision insurance?
All Affordable Care Act (ACA) and qualified health insurance plans must include vision coverage for children, but they don’t necessarily cover them 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.
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 $100, you’d have to pay those out-of-pocket costs before your insurance plan starts to pay for covered expenses. 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 is an allowance? An allowance is the maximum amount the insurance pays for a qualifying service. Often, the allowance is only available for a specified number of services in a certain amount of time. For example, if your plan has a one-time allowance of $80 per year for lenses, and you selected qualifying lenses that were $60, the plan would pay out $60. On the other hand, if you selected qualifying lenses that were $100, the plan would pay out $80 (the full allowance) and you would be responsible for the remainder of the cost. In both cases, another lens benefit would not be available until the following plan year.
- What other benefits does the plan cover? Most vision plans provide a yearly allowance to cover certain vision costs and/or glasses, including standard 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 products and services entirely out of your own pocket until your insurance coverage becomes effective.
Vision insurance can help pay for glasses, contact lenses — or both. Learn how today.
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 separate from your health plans. You can do this in 2 ways:
- Buy a stand-alone vision insurance plan. These plans often cover glasses, contacts or both.
- 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 annual eye exams and an allowance for prescription glasses and contacts. 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. Both types of plans allow you to pick your eye doctor and prescription eyewear. Benefits can include:
- Coverage for standard 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 may have reduced benefits.
- No waiting periods.
- Coverage for all ages.
Does your health insurance include vision benefits? A vision plan can be a good option. Explore one today, or contact a licensed insurance agent at 1-844-211-7730 for more information.
For informational purposes only. This information is compiled by UnitedHealthcare, and/or one of its affiliates, and does not diagnose problems or recommend specific treatment. Services and medical technologies referenced herein may not be covered under your plan. Please consult directly with your primary care physician if you need medical advice.
Source:
Healthcare.gov. “Vision Coverage.” Retrieved from https://www.healthcare.gov/glossary/vision-or-vision-coverage/ Accessed August 11, 2023.
Compliance code:
50403-X-0625
