You may already have a health insurance plan, but that does not mean your eye exams and prescription glasses are covered as well. The potential lack of this coverage can depend on two factors. First is where your insurance comes from, and the second is the age of the covered individual. The Affordable Care Act (ACA) mandate says that if you have marketplace insurance, your children up to the age of 19 have vision benefits. This, however, does not apply to adults.
You are not covered for routine eye exams or glasses if you have an individual policy, or if you are covered through your employer. These only cover vision problems if they came as a part of another, covered injury. Therefore, you need a stand-alone policy for vision benefits. Fortunately, they are not expensive and offer great coverage for any family size.
What is vision insurance?
Regular insurance covers injuries to the eye due to accidents. On the other hand, vision insurance is used for optometrists or ophthalmologists, for routine vision care. It also covers vision repair surgery. Without it, an eye exam can cost you $50-250. The prices depend on whether you go to an optometrist or ophthalmologist, is it a chain center or an independent doctor, tests that are needed, and if you need contact lenses.
This price is only for the exam, while frames and lenses cost hundreds of dollars more, with an average of $150 for frames and $90 for a single pair of vision lenses. Extras like progressive lenses, anti-reflective coating, or polycarbonate lenses are also not included in this price. So you see, not having vision insurance can be quite costly on a family, even if only two people in the family need assistance for example.
Average cost of vision insurance
Vision insurance also involves purchasing a policy, and is based on the annual premium and its monthly payments. These rates vary depending on where you purchased it, where you live, and if your kids are students.
For an individual
These can be as little as $5 per month, with most around $10-$15 per month, or $60-$180 per year. The yearly premium is actually less than an eye exam with glasses without the insurance.
For a family
The premium in some cases does not increase for families, so if for example, you have three kids, the fourth one will not affect the premium. For a family of four, about $40 to $80 per month is an average. This is again less expensive than two members with lenses while not covered.
What does vision insurance cover?
There are different levels of coverage, with standard, basic, enhanced, and advanced plans. They mostly differ in the amount of the premium. Generally, the following is covered:
The insured person is entitled to one vision exam per year. A co-pay of $10-$20 for most insurers is the norm. The benefit for frames is in the form of allowance, and depending on the level of coverage, you will get between $120 and $220, once per year. Eyeglass lenses are another co-pay, once a year and between $20 and $30. Either a co-pay or an allowance is the norm for contact lenses. When it comes to LASIK surgery, most of the insurers offer discounts that are generally around $500.
Everything else is offered at a discount, and it includes a scratch-resistant coating, anti-glare coating, polycarbonate lenses for stronger and thinner lenses, transition lenses that turn into sunglasses when in daylight, and progressive lenses.
What is not included?
Much like any other insurance policy, some things are not covered, which varies by the company. Some of the most common exclusions are additional exams, replacement of damaged or lost glasses unless without proper warranty, missed appointment charges, application fees, or other miscellaneous charges, non-prescription glasses, treatments to the eye that is medical, experimental or investigative procedures, and treatments where the doctor is a member of the family.
What are my best options?
Best vision insurance is available at the following three companies:
As the largest vision insurance company in the USA, they offer low copays, high allowances, and are widely accepted across the country. They won Best Vision Coverage from the Benefits Selling magazine Readers’ Choice Awards eight years in a row. The premium is around $15, depending on your area. Family plans are under $40.
This company received a four-circle per rating from J.D. Power. Over 44,000 independent and retail providers accept their plans. While others offer 205, EyeMed offers a 40% discount on a second pair of glasses within the policy year. They are a proud supporter of OneSight, which is a nonprofit organization providing vision care in underserved communities. Their individual plan is $5 per month, while the family plans start at $30.
Davis Vision is another company that has a four-circle rating for customer service awarded by J.D Power. Their plans are accepted at 70,000 nationwide points of access, while almost 9,000 offer the exclusive collection discount on assorted frames only available to their members. The company also provides a one-year warranty on the plan-covered glasses. Individual premiums are between $10 and $12, and family plans are around $30.
If you are lucky enough and your employer offers health insurance, dental and vision insurance may also be possible. Go with it, as this is surely the most affordable option for both the individuals and families.
Remember, vision insurance is important. Some might feel that they see clearly, and therefore have no need for glasses, so passing on vision insurance seems like a good idea. Make sure to check in with an optometrist or ophthalmologist, as they will help you determine your actual vision through their comprehensive eye exams.