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Understanding Vision Insurance

Looking for vision insurance?  Wondering what it covers – or what it won’t cover?  Is it included in your Obamacare plan?  Do you even need vision insurance?  If you do need it, how can you get it?  This article will help you answer these questions.

Vision Insurance – what it covers

Vision insurance typically covers the following:

  • Vision exams: Most vision insurance plans will cover one regular eye exam per person per year.
  • Vision hardware: This includes frames, lenses, or contacts. However, most plans will set a limit for how much you can spend on each item.  For example, they may set a cap at $120 for a set of eyeglass frames.  Coverage for your frames, lenses, or contacts may only be available on a limited basis per year.  For instance, you may qualify for contacts or lenses for your glasses once a year, but only qualify to purchase frames every other year. Some plans calculate your eyewear benefit on a calendar year, and others calculate it based on the date you last purchased your corrective eyewear.
  • Discounts: Some vision plans may provide you with additional discounts for vision care items and services. This may include things such as contact lens solution or even corrective eye surgeries like LASIK or PRK.

Vision Insurance – what it does NOT cover

Vision insurance typically will not cover the following:

  • Serious eye conditions: Care for medical eye conditions such as cataracts, glaucoma, or macular degeneration will not be supported by your vision plan. However, they are usually covered under your Obamacare medical insurance plan.
  • Elective surgeries: Corrective eye surgeries like LASIK or PRK are not covered by most vision insurance plans – though, as outlined above, many plans will offer discounts on these services. If the surgery is ordered by a doctor for medical reasons, then these types of surgeries can be covered under an Obamacare medical insurance plan.
  • Hardware extras: Special lens coatings such as polarization or scratch resistance are usually not covered by vision insurance plans.
  • Fitting fees: Some optometrists charge “fitting fees” for contact lenses to make sure the size and fit of the lenses are correct. These fees may not be covered by your vision insurance plan.

Vision Insurance – Is it included in my Obamacare Plan?

The Affordable Care Act (the law more commonly referred to as Obamacare or the ACA) does not require that health insurance plans include vision care, with one exception. Obamacare plans must include vision care for children ages 18 and under. This pediatric vision care must cover the following services*:

  • For children ages 18 and under:
    • Annual vision examinations for children under 18
    • Glasses lenses for children under 18
    • Glasses frames for children under 18
    • Contact lenses in place of glasses

Vision Insurance – Do I even need it?

It is important to remember that your vision can change over time, so even if you have never needed glasses or contact lenses before, it may be time to have your vision tested.

Optometrists can also check for changes inside your eyes that may be indicators of more serious medical conditions like glaucoma or macular degeneration. Having vision insurance means that you will be able to have access to these services whenever needed.

Vision Insurance – How can I get it?

There are several ways you can purchase vision insurance:

  • Vision insurance through an employer: Many employers offer vision insurance as a standard part of their benefits packages. This is how most people get their vision insurance coverage.
  • Private vision insurance you purchase yourself: Vision insurance isn’t only available through employers. You can also work with a licensed agent in your area or online who can help you buy your own vision insurance plan.
  • Vision rider plans: Some Obamacare health insurance companies that sell medical insurance directly to consumers will also offer vision plans as a “rider.” These plans are attached to the policy holder’s medical insurance plan.

Vision Insurance – tips when shopping for coverage

Now that you are ready to buy vision insurance, here are some tips when shopping for the eye care plan that best meets your needs:

  • Keep your optometrist if you like: If you already have a favorite optometrist, ask if they are an in-network provider before you pick a plan and apply for coverage.
  • The differences between “in-network” and “accepted insurance:” It is important to understand the difference between vision providers who are “in-network” and those who may “accept” your coverage but are not in your network. Out-of-network providers may be willing to submit claims to your vision insurance company on your behalf, but you may end up with higher out-of-pocket costs.
  • Vision insurance isn’t open-ended: Unlike medical insurance, vision insurance isn’t an open-ended line of coverage. For example, you may only be able to get an eye exam once a year and you may only be able to get contact lenses or glasses covered every one to two years. Your eyewear may only be covered up to a certain dollar amount, so you may pay higher out-of-pocket expenses if you choose frames or lenses that cost more than your limits. It’s important to understand your benefits before you incur unexpected costs.
  • Get the most from your vision benefits: To get the most from your benefits, you need to really understand them. For example, if your plan covers new lenses every year but frames every two years, plan to get new lenses in your old frames on off-years in order to keep a working back-up pair of glasses handy.
  • Combining vision benefits with medical spending accounts: Since your vision plan may not cover the full cost of your frames, lenses, or contacts, consider using funds from your Flexible Spending Accounts (FSA) or Health Saving Account (HSA) if you have one. This will allow you to offset the extra cost of your eye wear with pre-tax dollars.
  • Vision discount plans aren’t vision insurance plans: Be aware that a “vision discount plan” is not the same as a vision insurance plan. The discounts promised by a vision discount plan may not be available through the vision care providers in your area. Be sure to check with your preferred vision care provider to make sure they accept a discount card before purchasing one.

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