A Comprehensive Guide to Vision Insurance

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8 minutes read

Last updated: 06/29/2020
A Comprehensive Guide to Vision Insurance

Types of Vision Insurance

You can purchase vision insurance individually or through an employer plan. Policies are available for one person or for a whole family. There are four basic types of vision care coverage:

  1. Indemnity health insurance
    : you get to choose your provider.

  2. Health maintenance organization (HMO)
    : a network of providers that offers discounted prices as long as you use providers within the network.

  3. Preferred provider organization (PPO)
    : like an HMO, but allows you to use out-of-network providers, albeit with less coverage.

  4. Discount plans
    : these are simple plans that offer fixed discounts on various costs. This requires much less paperwork, but benefits are limited.

Vision insurance covers part of your care costs and can include deductibles and/or co-pays. It’s not part of the ACA health insurance program, so there could be issues with preexisting conditions. 

Covered Items

The ranges of covered items depend on the specifics of the vision insurance policy. You can expect a direct relationship between items covered and premium amount. Some items that vision insurance might cover include:

  • Eye exams and vision tests

  • Eyeglasses (lenses and frames) and contact lenses

  • Lens protection and photosensitivity

  • Treatment of various eye conditions

  • Eye surgery, including laser surgery

Even if your vision is perfect, you might want to carry comprehensive vision insurance to cover future problems, especially if you don’t have health insurance that would provide coverage. Eye diseases and injuries can happen at any time, and include:

  • Cataracts
    : this is a clouding of the eye lens. The condition develops slowly as we age. When cataracts become a serious problem, the treatment is surgery

  • Diabetic retinopathy
    : damage to the retinal blood vessels due to diabetes. It can eventually cause blindness. In the early stages, treatment is centered on the underlying diabetes. In later stages, surgery may be required

  • Glaucoma
    : a group of eye conditions in which high pressure in the eye damages the optic nerve. It’s a leading cause of blindness in older people. Treatment includes eyedrops, oral medications, laser therapy and surgery

  • Macular degeneration
    : can be the wet or dry type. The macular is the central portions of the retina, which thins and causes blurred or reduced vision. There’s no treatment for dry macular degeneration. The wet type can be treated with medications, sometimes accompanied by laser therapy

  • Retinal detachment
    : the retina is the light-sensitive part of the eye. The retina needs close contact with adjacent blood vessels in order to function properly. In a retinal detachment, the retina pulls away from the blood vessels and can be accompanied by floaters or flashes. Surgery or laser surgery are usually required to treat detached or torn retinas

  • Retinitis pigmentosa
    : a degenerative disease of the retina. Surgery might be required, including implantation of a retinal prosthesis

Only comprehensive vision policies will cover these types of diseases, since coverage is redundant with ACA health coverage.
Contact wearers might have to pay extra for options like daily disposable lenses. Some policies restrict exams to optometrists and ophthalmologists. Your vision insurance might not cover medical expenses, leaving that to your health insurance. Doing so helps tame heath insurance premiums.


Many plans carve out certain costs that they won’t cover. These might include:

  • Lenses other than basic ones. You might be on the hook for lenses that are progressive, photosensitive, scratch resistant, lightweight, ultra-thin and so forth

  • Frames other than basic ones. Plain plastic frames might be covered, but designer frames will cost extra

  • You might have to choose between eyeglasses and contacts lenses in any benefit period

  • Eye exam coverage might be limited to one visit every 12-to-24-months

  • Waiting periods for coverage to start can range from one week to three years, depending on the policy. These waiting periods make it harder for folks to buy insurance only after a problem is detected. Otherwise, the policies would be held only by people needing benefits, which could bankrupt the insurer

Cost of Coverage

Many factors influence the cost of eye insurance, which can have a monthly premium as little $10 to $20 per person. However, that rate only covers basic policies, and you’ll face co-pays and deductibles, as well as out-of-pocket expenses for coverage beyond the basics. You can get a more comprehensive policy, but it’ll significantly increase your monthly premiums. 
Cost factors include:

  • Insurance type
    : network plans with basic coverage are probably the least expensive, as long as you stay within your network. Discount plans, which aren’t insurance, are the cheapest type of coverage because they have the smallest benefits. A plan that has limited coverage for eye correction gear should cost considerably less than plans covering eye exams, LASIK surgery and vision therapy

  • Deductibles
    : costs are also sensitive to co-payments and deductibles. The higher the deductible, the smaller premium you’ll pay each month and the more out-of-pocket expenses you might experience

  • ·Location: eye doctors charge different rates in different locations. An Appalachian optometrist might charge half or less than one in Manhattan. This in turn influences the cost of vision insurance in your immediate area

  • Customization
    : you can cut insurance costs if you can customize the policy to your specific concerns. For example, you might not want to pay for new eyeglass every year and can save money by selecting biennial eyeglass coverage

  • Discounts
    : the issuer of your eye insurance policy might offer discounts on other types of policies, such as dental plans

  • Employer plans
    : Plans you get through your employer are usually less expensive than individual policies

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