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Contact Lenses

Is vision insurance worth it?

Here are the pros and cons of getting vision insurance for yourself. Written by Refractive Surgeon, Joel Hunter, MD.

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Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 11/21/19 10:42 AM

When you require routine preventive care for your eyes, chances are, your medical bills would rack up and eventually hurt your pocketbook. The passage of the Affordable Care Act (ACA) has made it possible for insured individuals to get eye care services, although ophthalmologists still debate over its impact on how accessible it has become for eye care patients in an analysis by the American Academy of Ophthalmology.

Nevertheless, the vision insurance industry has grown into a $36.9 billion business at an annualized 5.6 percent growth in 2019. In fact, vision coverage has increased to 87 percent in 2019 from only 53 percent in 2010 according to a survey report by the Kaiser Family Foundation.  

The challenge, however, is that research firms are expecting that employee cost sharing is also projected to rise in the coming years given the increase in health plan costs faced by employers according to PwC.

But with more people in need of eye care and treatment, vision insurance has now become a part of health benefit plans by top employers such as IBM, Southwest Airlines, JetBlue Airways, Pacific Air Systems, Haver & Boecker and Brown University. The better vision insurance employees and self-paying individuals get, the more that they’re encouraged to schedule their appointment with their eye doctor.

What is vision insurance and what does it do?

Vision insurance is a separate entity from health insurance that covers general eye care. It’s kind of like dental insurance in that they both have the same last name as health insurance, but are smaller with less responsibilities. At a medical insurance Thanksgiving, Vision and Dental would sit at the kids’ table with their glasses and perfect, healthy teeth.

Depending on your insurance provider, a vision insurance plan normally covers annual eye exams, eyeglasses or contact lenses, scratch-resistant coating and other related enhancements. You may also benefit from discounted upgrades on eyeglasses or extras on eye care services. In addition, some providers cover blue light protection and vision exams to identify risks for hypertension, diabetes, or glaucoma.

Some vision insurance providers also cover a portion of LASIK surgery so the total cost is reduced.

Since there’s a narrow range covered by a specialty insurance like vision insurance, the question of whether or not it’s worth it comes down to whether you’ve got the problem it seeks to fix.

If you’re thinking of how you can save with vision insurance versus paying out-of-pocket, here’s a sample computation.

 

Out-of-pocket Expenses

Employee Insurance

Self-paid Insurance

Basic Eye Exam (Annual)

$100

$0

$10 (co-pay)

Eyeglasses Frames (Once every year assuming a $150 allowance)

$200

$50

$50

Eyeglasses Lenses (Once every year)

$50

$10

$10

Anti-Glare Coating (Once every year assuming an $85 allowance)

$85

$10

$10

Cost of Insurance (annual)

$0

$150

$300

Total Cost

$435

$220

$380

Take note that these values are just sample payments but are close to what the market offers. As you can see, paying out-of-pocket will cost your more (although this may not always be the case).

Where can I get vision insurance?

Review your employer-sponsored health benefit plan if vision care is covered. These days, companies are willing to reduce your costs for preventive eye care and prescription eyeglasses or contact lenses as part of attracting applicants or keeping their current talent. You may also check your Medicare or Medicaid for possible coverage. If you have an open-access medical plan, you may avail of the services of any doctor or clinic that you prefer (although the coinsurance payment is higher if you go to an out-of-network eye doctor).

Companies also have more options these days based on the flexibility of plans. They can choose to have 100 percent coverage on in-network eye exams, pay for prescription drug costs, ask for lower premium payments for employees and even have an attached health savings account.

And for some insurance providers, members who do not want corrective eyeglasses can use it for non-prescription eyewear. It encourages them to come to the eye clinic so that they can be examined to prevent future complications.

If you are self-employed or cannot qualify for group insurance, then you can shop for individual or family vision plans in your area. The Affordable Care Act now allows self-employed (without any employees) to deduct 100 percent of their health insurance premium.  

How does vision insurance work?

For the wide swath of the American population that needs to see an optometrist once a year to get a new set of contacts and (slightly less often) glasses, vision insurance is super helpful. It works by paying a couple hundred dollars once a year to get large discounts for the costly process of getting new prescriptions.

That visit to the eye doctor that might normally be $100 or more becomes a steal at something like $10. A new pair of glasses, that could cost $150 all the way up to something infuriating like $600, might cost a tenth that amount with vision insurance. It makes the routine, annual expense of having—through no fault of your own—subpar eyes become significantly less burdensome.

Do you need vision insurance?

Here are the reasons for you to consider getting vision insurance.

You need routine check-up

The keyword here is routine. Most insurance is thought of as an in-case-of-emergency kind of expense. With vision insurance (and coincidentally, its cousin who always carries a toothbrush, dental insurance) the idea is usually the opposite. These are expenses involving a known, predictable, inconvenient money drain.

It’s annoying enough having to drag yourself to the eye doctor so that he can say your eyes are healthy and renew the same contacts prescription you’ve had for the last eight visits. It’s nice not to add a couple hundreds of dollars of cost as an extra punch in the neck. So, for folks who have an annual routine, and need to get their routine exam for their routine glasses or contacts, vision insurance is pretty great.

Life isn’t always routine though, is it? There are two big ways to break out of the routine. One is terrible and the other is fantastic. The terrible break to the routine occurs when something bad happens to your eyes. They’re vulnerable, those eyes of yours, and honestly it’s kind of amazing that eyes don’t get into trouble more often.

But when they do, there’s a whole world of troubles to explore. Whether it’s an injury or glaucoma or pink eye or a corneal ulcer caused by contacts—or one of a thousand other shocks that flesh is heir to—vision insurance won’t help. In those

situations when you need to fix something, it’s like having a large toolbox filled only with glasses. Luckily, most people who have vision insurance also have health insurance of some kind, which can step in as the adult in the room and help you through. Dental insurance, not wanting to be left out, will offer you his toothbrush.

The other break in the routine is quite the opposite. I hate to state the obvious (unless it’s a really fun obvious statement), but you don’t need to pay for glasses if you don’t need glasses. After LASIK, or refractive lens exchange or cataract surgery, one of the questions people will ask is, “Do I still need my vision insurance?”

And it’s fun because their face usually has some combination of a furrowed brow and a smile. I don’t tell people what to do with their insurance, but I really, really cherish being able to tell them for the first time, “Well, you won’t need to buy contacts anymore.” Vision insurance is worth it if you need it, but for most people it’s worth even more to not need it at all.

Your prescription changes every year

Vision insurance saves you a lot of money as you age. In fact, when you reach your 50s, it is recommended to have a annual eye exams to make sure that your vision is monitored and any eye disease or condition is discovered early. So, if your prescription changes faster, then paying for a new pair of eyeglasses or contact lenses can be a huge cost on your part.

You have family members that need it

Related to the reason above, you may even think of reducing the expenses for eye exams and prescription wear for your family with vision insurance. Children in need of new prescription more often than those who don’t can take a portion of your budget each time you visit the eye doctor. 

Medicare won’t cover your needed eye care services

There are four types of Medicare related to eye care. Medicare A, which is hospital insurance, covers cases that involve traumatic or medical emergencies.  Medicare B, on the other hand, covers vision care since it is considered medical insurance but does not cover eye exams, eyeglasses and contact lenses. Both types do not cover refractions for glasses prescriptions. Those with glaucoma can have screenings with Medicare B as well as have their eye prosthesis polished or resurfaced.

Medicare C is quite flexible that it may include routine vision exams and prescription drug coverage. Finally, Medicare D is a good addition to Medicare A and B because it covers prescription drugs. Both types are only offered by private insurers.

Chances are, your Medicare may not cover the eye services you need so taking vision insurance is necessary.

Your future earnings won’t be enough for vision care

Getting a new pair of prescription glasses regularly can be costly, especially when you anticipate you have other expenses to cover. With vision insurance, you’re compelled to save through low premiums on a monthly basis and can save a significant amount when you have to pay for new contact lenses, for example.

You have existing health conditions

If you are concerned about the effect of diabetes or high blood pressure on your vision, a routine check-up is highly important. Because anticipating future expenses can help you budget your finances, taking vision insurance can cover such payments.

Your eye doctor is an accredited service provider

If your optometrist or ophthalmologist is a part of the insurance’s network, you’ll likely be pleased with the cost reduction on your eye exams and other covered services. It is important to choose an insurer that has a wide network so you’re not limited by the options available and won’t be forced to pay for out-of-network benefits.

But when is vision insurance not a good buy?

Skipping vision insurance isn't a cause for you to go broke when you need your eyes checked. However, there are certain factors where taking vision insurance is not worth your time and money.

Like it or not, most vision insurance covers routine eye exams and partial costs for buying eyeglasses or contact lenses. If you can still read fine print or see objects at a distance clearly, then it makes no sense to spend for eyewear that has no use in the long-run (unless, of course, you want to look good with spectacles on). If you don't need to wear eyeglasses or contact lenses yet, an argument could be made for holding off your plans of buying an insurance for now.

When you couldn't find a plan that suits your finances and preferences, don't be forced into buying one just because you want insurance for eye care (or your friends have it). You may come across insurance providers that offer a discount-only plan so you can't have services covered in full. Some also offer coverage limited only to eye exams and nothing else. 

Some may also use their health savings account (HSA) or flexible spending account (FSA) from their employers when paying for eye exams or eyeglasses. When the fund available is enough to cover vision care spending, then insurance may not be needed. Sometimes an HSA can even cover LASIK treatment.

What is usually not covered by vision insurance?

Again, depending on your insurance provider, not all eye care services and treatments can be covered. First, if the service provider or clinic is outside your insurance’s network, then you may have to pay additional charges. In addition, non-prescription lenses, safety glasses, sunglasses, vision therapy, light sensitive lenses, prescriptions and eyeglass tinting, orthoptics and lost lenses are generally not included. Furthermore, some benefits such as elective conventional lenses have a limit on the amount covered and the rest has to be paid by the insured.

As with any type of insurance, cost-effectiveness is a major factor in choosing the correct one. Now that companies have made it flexible for their employees to get lower co-payments and deductibles, affordable vision care can be within reach.

However, if you want LASIK, and your insurance doesn’t cover LASIK, then you’ve still got other options.

Contact Hunter Vision today to schedule your appointment at our Orlando, Florida LASIK clinic, or call 321-234-3495, or email us at info@huntervision.com.

Our affordable payment plans for vision correction surgeries including LASIK can fit your budget. That's why we offer

payment plans for as low as $130 per month - so you can start and end your day without your eyeglasses.

Are there alternatives to vision insurance?

As I’ve mentioned, not taking vision insurance isn’t the same thing as skipping on your health insurance. That’s because there are also alternative solutions to the former but hey, I’m not here to argue which one is better. All I’m presenting are ways to get eye care more affordable, especially to patients that are on a tight situation.

You may apply for a health discount card to help you save almost half of the price of vision services depending on your eye doctor. Take note, however, that this is not equivalent to insurance, but does provide a convenient and affordable benefit package that may include price discounts on prescription drugs, chiropractic care, nutritional supplements, dental care, and podiatry exams depending on the provider.

You may also decide to join a medical cost sharing network. This involves sharing the cost of members’ medical bills but come with lower monthly premiums. To keep costs down, service providers encourage members to maintain a healthy lifestyle so that medical services are kept low.

Then there are independent prescription retailers from wholesalers that offer quicker and upgraded services to shoppers. They have optometrists ready to assist patients and offer basic to premium eyeglasses for a fraction of the price in high-end optical shops. Some, to make their services more competitive, now offer free vision exams in their mall-based vision centers and have also ventured into online retailing (although you still need a prescription for contact lenses before you can get a pair).

Author:Joel Hunter, MD is an Ophthalmologist, Refractive Surgeon, and the Founder of Hunter Vision, a LASIK Clinic in Orlando, Florida. A recognized and respected specialist in vision correction who has performed a countless number of refractive surgeries, Joel gives lectures across the country and trains fellow doctors in the newest LASIK surgery techniques.

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