Vision Insurance Overview

People with vision insurance are twice as likely to schedule a routine eye exam as those who do not. And according to many optometrists, “a very thorough eye exam will catch eye disease and discover health issues you may not have known you have, such as high blood pressure, diabetes, even brain tumors.”

 

What Vision Insurance Covers

Like health insurance, vision insurance can aid with the cost of examinations, treatments, prescriptions, surgical procedures, and equipment. Some of the things most commonly covered by vision insurance plans include:

Eye exams. This preventive care measure is generally performed once a year and involves a series of tests to gauge the health of your eyes across several different parameters. The things tested for during an eye exam can include the sharpness of your vision, color blindness, how your eyes work together as a unit, a presence of glaucoma, your range of peripheral vision, and more. Eye exams can be instrumental in providing an early detection of eye disease, any developing vision problems, or a need for corrective lenses. 

Eyewear. Glasses (frames and lenses alike) and contact lenses can be expensive but are often at least partially covered by vision insurance. Some vision insurance plans may limit coverage to eyewear purchased through your optometrist or a network-approved vision center. Sometimes, even prescription sunglasses may be covered. 

Lens coatings and enhancements. Some vision insurance plans can help with the cost of a lens coating. Lenses can be coated with substances to decrease scratching, fog and moisture, reflections, and exposure to ultraviolet rays. 

Surgery. Surgeries that are deemed medically necessary, such as a procedure to treat an eye injury, infection, or disease, will often be covered by a health insurance plan. But corrective surgery, such as LASIK, is generally not covered by health insurance because it is deemed by many insurance providers to be an elective or “cosmetic” surgery. However, there are some vision insurance plans and discount programs that will partially cover such elective procedures.

 

Cost of Vision Insurance

Service

Cost Without Insurance

Cost with Insurance

Savings With Insurance

Eye Exam

$154

$15 (Copay)

$139

Frames for Glasses

$159

$9

$150

Eyeglass Lenses

$86

$25 (Copay)

$61

Lens Enhancements

$268

$170

$98

Total

$667

$423

$244

 

In the example above, you can see the savings for a pay of glasses and exam was $244 for a pair of glasses and an eye exam. Some may ask, well you did not include the cost of the vision insurance itself. The average market cost per plan is somewhere between $6-$10 per covered person. Even if you take that into consider on the high end $10 *12 = $120 (Year of coverage); you would still walk away with $124 dollars in savings per person (From example, $244 (Savings) – $120 (Cost of Insurance).

 

Vision Insurance in the Workplace

Under the Affordable Care Act, companies with at least 50 employees are required to provide group health insurance for their employees or face a penalty. However, vision and dental insurance are not required as part of this mandate. 

As a result, vision insurance benefits granted by an employer-sponsored plan are the exception, not the rule. In fact, only 35 percent of companies that offered health insurance in 2014 provided any sort of vision benefits.

Meanwhile, from Phoenix’s experience, the two most popular voluntary benefit programs for employees are vision and dental insurance.

Vision Insurance for Children

While vision and dental insurance for adults is not a requirement of the Affordable Care Act, vision benefits for children is a required benefit offer under all plans that qualify as “minimum essential coverage.”

This means that all children under the age of 19 enrolled in individual, family, and small group health insurance plans must be offered basic and preventive care for vision.


If this all seems complicated, a licensed insurance agent can help you understand the options that are best for you and your family. Our Phoenix Captive Solutions staff are always more than willing to help.

This article was written by Phoenix Captive Solutions C.F.O. Blake Coats, any views or opinions do not necessarily reflect the opinions of either Phoenix Captive Solutions LLC, or any associated entities.  

Feel free to write to Blake at blake.coats@phoenixcaptive.com  



Leave a Reply