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HomeHealthEverything you need to know about vision insurance

Everything you need to know about vision insurance

It can help protect you from serious eye diseases.

 Pete Hastert has diabetes and a good reason to worry about his eyesight. “My grandmother went blind from complications of diabetes,” he says. However, Hastert hasn’t had an eye exam in more than thirty years. The 71-year-old retiree from Tupelo, Mississippi, did not have vision insurance and, because money was tight, he avoided seeing an ophthalmologist. Later, he learned that there are volunteer ophthalmologists who do comprehensive exams at no cost through EyeCare America’s Seniors Program. Hastert made an appointment, and his eyes turned out to be healthy. “I’m finally calm,” he says.

It is important to have a comprehensive annual dilated eye exam; assesses your ability to see, detects age-related vision problems, and even helps detect chronic conditions like diabetes. Almost 2% of people age 40 and older have glaucoma. In adults over the age of 50, age-related macular degeneration (AMD) is the leading cause of severe vision loss.

However, good vision insurance is not something that can be taken for granted. “Cost is one of the key reasons people don’t get eye exams,” says Julian Roberts, executive director of the National Association of Vision Care Plans. But there are options, even for those on very tight budgets.

The two types of coverage

Keep in mind that there are two types of vision care: one that takes care of your daily vision, primarily glasses or contact lenses, and the other that treats eye diseases and eye injuries.

Health insurance

Your regular health insurance will cover the cost of diagnosing and treating an eye injury or illness that requires a doctor’s help—just like a broken bone or heart disease—although copays and usual deductibles.

Health insurance does not cover the cost of eyeglasses, contact lenses, or other costs related to daily vision support. But there is undefined ground. Although it typically doesn’t cover a simple refractive exam (used to determine eyeglass prescriptions), if your ophthalmologist diagnoses you with a medical problem, such as glaucoma or cataracts, the entire visit may be billed under Eyemed insurance, he says. Josh Ehrlich, MD, Associate Professor of Ophthalmology and Vision Sciences at the University of Michigan in Ann Arbor. (Check with your doctor for specific office policies.)

That creates a small problem since the exams are not covered unless you are diagnosed with an illness. But the best way to diagnose it is by examination.

vision insurance

It pays for services like routine eye exams, plus a high percentage of the cost of glasses or contacts. Upgrades like anti-reflective coating on the lenses and transition glasses aren’t usually covered, but read the fine print to see if any of the cost will.

Many people get affordable vision insurance through their employer: You pay a couple of dollars a month, as an addition to your current health benefits, and your employer pays the rest, explains Danielle Kunkle Roberts, co-founder of the Boomer Benefits insurance agency.

Even if you’re one of the lucky ones whose eyesight is still healthy, it’s a good idea to take advantage of your employer-provided vision plan, because you’ll likely need vision correction in the near future.

“We did a study of adults 65 and older, and we found that 92% wore glasses to correct distance or near vision,” says Josh Ehrlich, a Michigan professor who co-authored the study published in 2018 in the journal medical JAMA Ophthalmology. Dr. Charlotte Yeh, medical director of AARP Services, recommends that everyone over the age of 50 have a comprehensive annual dilated eye exam. 

Find Independent Coverage

If you don’t have access to vision insurance provided by your employer, you can purchase a plan from a private insurer. But that requires a good price comparison strategy.

discount plans

Pay a monthly fee to access comprehensive eye exams and discounted glasses at a select network of doctors and vision centers. “This is a great option if you’re looking to get a little help with the cost of routine vision services,” says Kunkle Roberts. Check memberships you already have: AARP Vision Discounts provided by EyeMed, AAA, and merchants like Costco may offer cost savings.

Vision benefit packages

These plans work much like traditional insurance coverage. You pay a fixed amount, as well as a copay for the exam, glasses, and contact lenses. Look for these packages through an insurance agent, buy them online, or contact your state insurance department for information. You may also be able to add a vision insurance policy to your dental insurance plan.

“All networks have significant options for consumers, from independent optometrists to stores like LensCrafters or For Eyes, and even Costco, Sam’s Club, and Walmart,” says Roberts. But in the end, it may be better to save the money you’d spend on insurance and put it toward the cost of your glasses. He calls up a few vision centers and asks them these questions: If I pay cash, how much would a comprehensive eye exam cost? What is the cost of contact lenses, eyeglasses, and upgrades like an anti-reflective coating? Is there a discount for paying in cash? It might surprise you how much prices can vary. He then compares that to what you’d pay for a vision plan and makes a decision with those elements in mind.

What happens if you don’t have insurance?

Even if you don’t have insurance through Medicare, your employer, or the marketplace, you should try getting a baseline eye exam.

EyeCare America’s Glaucoma Program is an option for people who do not have insurance and are at higher risk of glaucoma. Such people receive a free screening for glaucoma (a disease that often has no symptoms). Adults 65 and older are eligible for a free medical eye exam under EyeCare America’s Seniors Program, and those diagnosed with an eye disease will receive up to a year of follow-up care.