Health Insurance and Eye Care Coverage

Much like dental and hearing care, standard health plans in the U.S. rarely cover vision care. Why is that the case? And what other insurance options are available to Americans who want to cut their eye-care costs? Keep reading for answers to both questions and many more.

optomologist helping patient

Have you read our article, "Does My Health Insurance Plan Cover Dental Care?" If so, you know the answer to the question posed by its headline is "not usually."

Well, the same answer can be used on this similar question: does health insurance cover vision care?

Why don't most basic health plans help people pay for eye exams, glasses, contacts, and the like? You'll learn about all of that--and a number of related topics--in this article.

First, though, let's talk about the importance of routine vision care.

Why Is Eye Care Important?

Regular trips to the "eye doctor"--or optometrist--aren't just important for people who have vision problems. They're also important for people who have little or no history of such issues.

That's because eye exams do more than just test your vision. And optometrists do more than simply correct changes, via prescription glasses or contact lenses, they notice during those exams.

For example, your optometrist may see the early signs of eye disorders such as cataracts or glaucoma during a routine or annual exam. Also, he or she may spot general health issues like diabetes, high blood pressure (hypertension), leukemia, or sickle cell anemia before they become more apparent or serious.

As is almost always the case with these sorts of things, detecting them early can make a huge difference in your ability to manage and treat them.

Why Doesn't Health Insurance Usually Cover Vision Care?

Given what was just said, it doesn't make a whole lot of sense that most U.S. health insurance plans don't cover eye care, does it?

Actually, it makes at least a little sense when you consider that most American health plans don't cover dental or hearing care either.

As for why that is, the answer seems to be a two-parter. 

For starters, there's the fact that, historically, health insurance in the United States has focused on the medical community and medical care.

Although most people today think of vision, hearing, and dental treatments and services as being "medical" in nature, that hasn't always been the case. In fact, up until fairly recently, physicians, hospitals, and insurance companies didn't consider dentists, optometrists, ophthalmologists, and the like to be "real" doctors.

Things have changed a great deal in that regard, of course, but the health insurance stigma or bias against dental, hearing, and vision care continues to be a reality.

So what's the second reason why health insurance plans in this country tend to turn their noses up at eye care? As Sara Teachout, Blue Cross Blue Shield of Vermont's director of government, public, and media relations, points out in this article, insurance companies like hers often follow the lead of Medicare and Medicaid.

Both Medicare and Medicaid rarely, if ever, pay for routine eye exams, glasses, or contacts, so it shouldn't be surprising to hear BCBS and many other health insurers similarly pass on that coverage.

That's not always true, however. Some health insurance policies do cover vision or eye care. Here's a bit of information on how various types of plans deal with the issue.

How Do Job-Based Health Insurance Plans Treat Vision Coverage?

If your goal is to have health insurance that helps you pay for eye exams, eyeglasses, contact lenses, and more, do what you can to join a company that offers it to employees.

After all, job-based or employer-sponsored health plans are your best bet when it comes to that kind of coverage.

Even then, though, the coverage usually isn't provided through the employer's health insurance policy or policies. Instead, it's provided through add-on plans that specifically focus on vision care.

Don't worry, you'll learn more about those plans below.

Do Obamacare Marketplace Plans Offer Vision Coverage?

Thanks to the Affordable Care Act, also called the ACA or Obamacare, almost all health insurance policies sold via the government-run marketplace (or exchange) have to cover 10 categories of services in some form or fashion. Most off-marketplace health insurance policies, or policies bought directly from insurers, have to cover them, too.

Unfortunately for Americans who'd like some help with their eye-care costs, vision coverage isn't one of these "essential health benefits." Or at least it isn't as far as adults are concerned. Nearly all marketplace plans, and many off-marketplace plans, have to cover vision care for children, but the same isn't true of adults. (This is despite the fact that the ACA requires marketplace and many other plans to cover general preventive care for Americans of all ages. If you'd like to learn more about that, by the way, read our article about health insurance and preventive care.)

That's not to say Obamacare keeps marketplace health plans from providing vision-care coverage to adults. Insurers are free to offer them this coverage, actually, and some do. To find a marketplace policy that includes vision coverage, shop around. Take a close look at the plans you encounter on the federal or state exchange.

If you can't find a marketplace or exchange policy that provides eye-care coverage, you'll need to look elsewhere for stand-alone vision plans. For whatever reason, the marketplace doesn't sell them.

Do Off-Marketplace Health Plans Cover Eye Care?

Like the marketplace plans detailed above, Obamacare doesn't require off-marketplace plans, or health plans you buy directly from an insurance company, to include vision coverage for adults.

Some of these plans cover vision care anyway, though, so keep an eye out for that while you shop for health insurance.

And there's always stand-alone vision plans that focus entirely on eye-care coverage if you can't get what you want from a standard health insurance policy.

By the way, if you're ever stumped and need help finding the right off-marketplace health plan or even stand-alone vision plan, contact your state’s Department of Insurance.

Does Medicare Provide Vision Coverage?

Original Medicare, or Medicare Part A and Part B, helps Americans pay for a lot of services and treatments, but it doesn't help them with many types of vision or eye care. For example:

  • Medicare Part A covers eye injuries or problems that take you to the emergency room or hospital.
  • Medicare Part B covers some preventive and diagnostic vision exams and screenings.
  • Medicare Part D can cover prescription drugs that are needed to treat eye diseases like glaucoma.

Besides the above, Medicare (Part B, specifically) also covers the following when they're medically necessary:

  • cataract surgery
  • one pair of glasses or contact lenses after cataract surgery
  • artificial eyes or ocular prostheses

That's about it as far as Medicare coverage of eye or vision care is concerned, however. Neither Part A, nor B, nor C help enrollees pay for things like routine eye exams, glasses, or contact lenses.

For that kind of assistance, you need to buy a Medicare Advantage plan. Or you need Original Medicare plus a Medicare Supplement, also known as MedSup or Medigap, policy.

Heads up: MedSup plans usually don't offer dental, hearing, or vision coverage. Some do, though, so if you want one that chips in for your eye exams, glasses, or contacts, you'll probably have to dig around a bit.

To learn more about these supplemental Medicare policies, read our "Guide to Medicare Advantage Plans" or this article: "When Does it Make Sense to Get a Medicare Supplement Plan?" You may want to read our write-up about dental, hearing, and vision care with Medicare, too.

Another option is to buy a stand-alone vision plan directly from an insurance company.

Does Medicaid Cover Eye Care?

As is true of ACA marketplace plans, state Medicaid programs have to cover certain kinds of eye care for children of need who are under the age of 21.

Specifically, Medicaid covers children's:

  • eye exams and screenings
  • eyeglass frames
  • eyeglass lenses

A number of states provide the same or similar coverage to adults. Many also cover glaucoma screenings for enrollees over the age of 21.

Finally, all Medicaid programs pay for at least a portion of the cost of cataract surgery when it's considered medically necessary.

For more information on how your state Medicaid program covers eye or vision care, or to see if you're eligible, contact your local agency.

What Can I Do if I Can't Get Health Insurance That Covers Vision Care?

Your best option if you don't have access to or if you can't find health insurance that covers vision care is to buy either stand-alone vision insurance or a vision discount plan.

Here's how the two differ from one another:

Vision insurance is a lot like other types of insurance you might buy. You pay a monthly premium for it, and in return it pays for some of the costs of any eye-care needs that have to be addressed while it's in force.

Vision discount plans actually cover most of the same forms of eye care as vision insurance plans. Here, though, you usually pay an annual fee to join and after that you simply get discounts--of between 15 percent and 35 percent, typically--on things like exams, glasses, and contacts.

Why Should I Buy Vision Insurance or a Vision Discount Plan if My Health Insurance Plan Doesn't Cover Eye Care?

Both vision insurance and vision discount plans can save you a lot of money--especially if you need eyeglasses or contact lenses or otherwise have a history of vision problems.

That's particularly true of vision insurance, as it's like most other kinds of insurance in that you pay a premium to maintain it and then it covers a good portion of your eye-care costs after that. (Though most vision insurance plans make you cover a small copayment or copay whenever you go in for an exam or buy glasses, too.)

What Does Vision Insurance Cover or Pay For, Anyway?

Vision insurance policies usually cover basic eye-care needs like routine visits to an optometrist and prescription eyewear (glasses and contacts) purchases.

Most won't cover vision correction surgeries, such as LASIK and PRK, or cosmetic services, but they may offer discounts on them.

A few things to note here:

  • It isn't unusual for vision insurance policies to limit coverage in various ways. For instance, a plan might only pay up to $100 or $200 for glasses. Anything above that is your responsibility.
  • Most vision plans are tied to networks. That means only the eye care you receive from an in-network optometrist is fully covered. If you go to someone outside that network, you'll pay more of the resulting bill than you would otherwise.

What Doesn't Vision Insurance Cover?

Vision insurance policies usually don't help pay for the following:

  • vision correction surgery like LASIK or PRK
  • any services that are considered "cosmetic" (such as tinted lenses)

Some vision plans also don't cover daily disposable contact lenses.

That said, some stand-alone vision plans offer discounts in these areas, so look for or ask about them as you shop for this kind of insurance.

How Does Vision Insurance Work?

Vision insurance works like almost any other type of insurance you can buy. After settling on a plan, you pay a monthly premium to maintain it. In many cases, when you go to receive care, you have to cover a copayment. Some policies have deductibles that need to be met as well.

With all that out of the way, the plan pays for a good portion, if not all, of the eye care you receive during the policy period. Sometimes limits or "allowances" are involved, such as when you buy glasses or contacts, but not always. In those situations, though, the policy should spell out exactly how much it'll contribute and how much you have to pay out of your own pocket.

How Much Does Vision Insurance Cost?

How much you pay for vision insurance depends on where you get it.

If you get it through your employer, you may not pay a penny for its coverage. Don't be surprised if you have to pitch in at least a few dollars, though. The average seems to be around $3 to $5 per month.

If you have to get it on your own, directly from an insurance company, you'll obviously need to pay something, but perhaps not as much as you think. In fact, most vision insurance policies sold today come with monthly premiums of less than $20.

What Do Vision Discount Plans Pay For or Cover?

Vision discount plans tend to cover the same types of eye care that stand-alone vision insurance plans cover.

That means they usually cover things like:

  • routine eye exams and screenings
  • prescription eyewear (glasses and contact lenses)

They often cover certain surgical procedures (such as LASIK or PRK), too.

The main difference between how vision insurance and vision discount plans cover these products and services, though, is that vision discount plans only provide you with a discount on them. Those discounts can be surprisingly meaty, however--as much as 35 percent or more. Combined with the low annual fees attached to most of these plans, they can translate to a good amount of savings.

What Don't Vision Discount Plans Pay For or Cover?

Again, like vision insurance policies, vision discount plans cover most of a person's eye-care needs. They don't cover them fully, though. In fact, they only provide discounts on things like eye exams, glasses, and contacts.

Some discount vision plans won't help you save money on cosmetic services or corrective surgical procedures, but many will.

The only way to know which services and purchases a particular plan does and doesn't provide discounts for is to do your research and ask plenty of questions.

How Much Do Vision Discount Plans Cost?

Given all of the different policy and coverage options currently available to Americans, it's hard to say exactly how much you might pay for a vision discount plan.

One thing is certain: you'll pay less for a vision discount plan's annual fee than you'll pay for a stand-alone vision insurance policy's monthly premiums over the same period of time.

In the end, you could pay as little as $30 a year for an individual vision discount plan or $50 a year for a vision discount plan that covers your whole family.

As always, if your goal is to get the most eye-care coverage for your buck (or at least the best eye-care discounts for your buck), shop around. Compare fees and other costs from a wide range of companies before choosing one over another.

Where Can I Buy Vision Insurance?

A number of companies sell vision insurance policies or vision discount plans these days. Here are some examples:

  • Aetna
  • Ameritas
  • Blue Cross Blue Shield
  • Davis Vision
  • EyeBenefits
  • Humana
  • UnitedHealthcare
  • Vision Plan of America

Should I Buy Vision Insurance or Should I Buy a Vision Discount Plan?

This is a question only you can answer based on your own eye health, your family history in this area, and how much you think you may spend on vision care in the coming months and years.

That said, here are two things you should keep in mind while you weigh these two options:

  • The fee you pay to join a vision discount plan should cost less than what you'll pay for vision insurance premiums in a given year.
  • If you go with a vision discount plan, you'll likely pay more out of pocket for things like eye exams, glasses, and contacts than you would if you went with stand-alone vision insurance.

In other words, shop around and make note of how much each of the above components cost for any plan that catches your attention. Then compare and contrast those amounts to see how much you might have to pay if you have to see an eye doctor, replace your glasses, or buy new contact lenses in the next year or two.

Why Shouldn't I Just Pay for Eye Care Out of My Own Pocket When it's Needed?

Actually, this may be the best idea for you if you don't have a history of eye problems and if you also don't have a family history of eye problems.

After all, people who rarely, if ever, need to visit an eye doctor, or who don't need prescription glasses or contact lenses, may not save any (or much) money by enrolling in a vision insurance plan or by joining a vision discount program. In fact, some will lose money in those situations thanks to the fees or premiums they'll have to pay to maintain the policies.

If you have "bad eyes," though, and glasses or contacts have been a part of your life for years, you should at least look at vision insurance or vision discount plans if you don't have access to health insurance that covers such things. The same is true if other members of your family have histories of vision problems or issues.

In such cases, vision insurance or vision discount plans could save you a lot of money. How much money could they save you? Consider the following:

  • Depending on where it's done, a routine eye exam can cost you as little as $50 or as much as $100 or more if you pay for it out of your own pocket.
  • Out-of-pocket costs for glasses can be anywhere from $100 to $500 and above.
  • With vision insurance, you may pay just $15 or $20 for an eye exam (as long as you see an in-network optometrist).
  • As for glasses, you could pay as little as $100 for them if you have a stand-alone vision plan.

Before you hand over your hard-earned cash for vision insurance or a vision discount plan, though, do your homework. Not all of these policies are created equal. Some cost more than others, and some provide more coverage than others. Make sure the one you choose offers the coverage you need and at the price you want.

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