Do You Know About Your Vision Insurance?

Vision Insurance Overview - Start Your New Year Out Right!

Vision insurance policies typically cover routine eye exams and other procedures, and provide specified dollar amounts or discounts for the purchase of eyeglasses and contact lenses. Some vision insurance policies also offer discounts on refractive surgery, such as LASIK and PRK.

Potentially high costs of routine eye examinations and prescription eyewear can be of real concern, especially for large families. You might be able to defray at least some of these costs by looking into acquiring vision insurance for yourself or better understanding the plan your company already provides.

Vision insurance only supplements regular health insurance. Regular health insurance plans protect you against financial loss due to unexpected eye injury or disease.

Vision insurance, on the other hand, is a wellness benefit designed to reduce your costs for routine, preventive eye care such as eye exams, eyewear and other services.

Where Can I Get Vision Insurance?

Group vision insurance can be obtained through your company, association, school district, etc., or through a government program such as Medicare or Medicaid.  If you are not eligible for a group plan because you are self-employed or for other reasons, most vision insurance providers also offer policies for individuals that you can purchase separately.

Vision insurance often is a value-added benefit linked to indemnity health insurance, health maintenance organizations (HMOs) and preferred provider organizations (PPOs) that have contracted with managed vision care networks to provide eye care services.  Indemnity health insurance is traditional health insurance that allows policyholders access to medical providers of their choice.

An HMO is a group of healthcare providers — doctors, laboratories, hospitals and the like — employed to provide health care to plan members at discounted rates. Usually, plan members are required to access health care (including vision care) only from HMO providers.

A PPO is a network of healthcare providers organized to provide healthcare services to health plan members at a fixed rate below retail prices. Plan members may opt to access out-of-network providers, but usually at a greater cost.

When you buy vision insurance, you receive the following benefits:

Access to a network of providers, including optometrists and ophthalmologists, eyewear stores, optical laboratories and LASIK surgeons

Routine, preventive eye care services at reduced rates

What Kinds of Vision Insurance Plans Are Available?

Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan.

Typically, a vision benefits package provides free eye care services and eyewear within fixed dollar amounts in exchange for an annual premium or membership fee and a relatively small co-pay (fixed dollar amount) each time you access a service.

A discount vision plan, on the other hand, provides eye care and eyewear at discounted rates after you pay an annual premium or membership fee.  In some cases, a vision benefits package or discount vision plan may also include a "deductible" — a fixed dollar amount you must pay your eye care provider out-of-pocket before the insurance benefits take effect.

Both kinds of vision insurance can be custom-designed to meet the requirements of a wide range of customers, including school districts, unions, and big and small companies.

Vision insurance generally covers the following basic services:

Annual eye examinations,  eyeglass frames, eyeglass lenses, contact lenses and discounted rates for LASIK and PRK

Generally, services acquired from network providers cost less than services from out-of-network providers.

Also, a reputable vision insurance company should have a quality assurance mechanism to answer your questions and help you resolve any disputes or issues you have with a vision care provider in your plan's network.


What Does Vision Insurance Cost?

Vision insurance costs vary, depending upon how the program is designed. Costs also may vary based on your state of residence.  As an example, one nationwide vision insurance provider offers the following 2011 rates for individual (non-group) vision insurance plans to New York residents:

Vision Benefits Package

Annual membership: $170.95 for singles; $428.95 for families (includes $10 one-time enrollment fee).   Routine eye exam: covered in full (after $15 co-pay)

Eyeglass lenses — single vision and lined bifocals or trifocals; polycarbonate lenses for children: first pair covered in full (after $25 co-pay)

Eyeglass frames: up to $120 benefit, plus 20 percent off any out-of-pocket expenses (after $25 co-pay)

Contact lenses (instead of glasses): $120 allowance for cost of contact lens exam, fitting and lenses

Other discounts: 20 to 25 percent discounts for eyeglass lens options and extra pairs of glasses (including sunglasses)

Vision Discount Plan

Annual membership: $69.50 for singles; $149.50 for families

Routine eye exam: 20 percent discount,  eyeglass lenses (single vision and lined bifocals):
20 percent discount, eyeglass frames: 25 percent discount, contact lens exam fees: 15 percent discount, laser vision correction: 15 percent, non-prescription sunglasses: 20 percent

It's a good idea to comparison shop several vision insurance providers to make sure you get the best value for the eye care benefits you desire.

Typically, you pay for group vision insurance through payroll deductions or flexible spending accounts (FSAs).  An FSA, sometimes called a cafeteria plan, allows an employee to use pre-tax dollars to purchase selected health benefits such as vision insurance. You save money because you pay for the policy with income that has been set aside for health costs and is not subject to taxation.

If you purchase an individual vision insurance plan because you are self-employed or your employer does not offer vision insurance, you can expect to be billed monthly or annually.

By Madeleine Vessel; additional contributions by Gary Heiting, OD

Vision Insurance News

More on Vision Insurance

Why Are Visually Impaired Americans Not Getting Eye Care?

Mainly It's Cost, Lack of Insurance and No Perception of Need

May 2011 — If you were visually impaired or had an age-related eye disease, would you get regular eye care? Many Americans aged 40 and over with these problems don't, says the government's Centers for Disease Control and Prevention (CDC).

Eye care cost or lack of health insurance (39.8 percent) and perception of no need or not having thought of it (34.6 percent) were the most common reasons cited when people were asked why they hadn't visited an eye care provider in the last year. And while 21.1 percent chose the "other" response, more specific reasons were "do not have/know an eye doctor," "too far, no transportation" and "could not get appointments."

Men were more likely than women to report no need for eye care (41.7 percent vs. 28.7 percent). Also, those 65 or older reported this more than those aged 40-64 (43.8 percent vs. 32.9 percent). "A possible reason for this is that older adults might regard impairment as a normal part of aging," wrote the study authors.

The authors also noted that a previous study had shown that primary-care providers were not adequately highlighting the need for eye care to their patients.

Regarding cost and lack of insurance, only 21.6 percent of Massachusetts respondents aged 40-64 chose that reason for not getting eye exams. But in Tennessee it was 60.4 percent. For those 65 and older, in Massachusetts it was 8.9 percent, but in West Virginia it was 48.0 percent. As the study authors noted, Massachusetts is the state with the smallest percentage of residents with no health insurance.

The CDC's analysis used data from Behavioral Risk Factor Surveillance System surveys, a series of annual, state-based phone surveys, conducted from 2006 to 2009. Data from 21 states were used in the analysis, with a sample of 11,503 adults aged 40 or over with self-reported moderate to severe visual impairment who had not visited an eye care provider in the previous year.  The definition of "visual impairment" was difficulty in recognizing a friend across the street and in reading various types of printed material.


The study report appeared on May 20 in the CDC's Morbidity and Mortality Weekly Report.