Vision Coverage is Complicated

When people talk about vision insurance, they might not be fully aware of what they are talking about.  There are actually two different ways to get some of the costs covered when a person needs an eye exam and possibly glasses or contact lenses.

Vision Insurance coverage is pretty much like a major medical insurance plan, but just for vision.  The other variety of vision coverage is called a wellness/discount plan.

Comparing the Two  

Both the traditional vision insurance and the discount plan cover routine preventive eye care.  This would include an annual eye exam and prescription eyewear.  

It’s the way they cover the services that are different.

With traditional vision insurance, a patient sees the eye doctor and pays a co-pay just like a medical policy. Then the insurance company pays the eye doctor according to the policy. 

When a patient sees an eye doctor under a discount plan, the patient pays for the services but they pay a lesser amount than is charged to other patients.  

With a traditional vision insurance policy, you can choose a more robust plan that could cover lens coatings and progressive lenses.  With discount plans, this is generally not included.   Some insurance plans and discount plans will cover elective surgery such as LASIK. 

With both kinds of vision coverage, the patient must be careful to choose an eye doctor who accepts the kind of plan they have.  

With discount vision plans, the patient typically must choose between glasses or contacts.  The plan will not offer a discount on both.  

Fortunately, both traditional vision insurance and vision discount plans can be used with the patient’s HSA account.  In this way, patients can take money out of their health savings account or their flexible spending account to pay for upgrades and co-pays.  

Is it Even Worth It?

If a patient has perfect vision and doesn’t need glasses, the cost of vision insurance or vision discount plans just isn’t worth it.  These people would only need routine exams which would cost less than the cost of a year of premiums. 

However, if a person knows they need glasses, it’s a toss-up.  Traditional vision insurance costs more than vision discount plans.  So a person would need to shop around and examine the prices.

First, it’s important to find out what the eye doctor usually charges for exams.  In some cases, the cost of a routine eye exam is less than the cost of a year’s worth of insurance premiums.  Then the patient must investigate the cost of the frames and lenses that they would probably buy, and find out the cost of contact lenses.

Next, they would have to compare the premiums on the plans they are thinking about.  Different companies will have different premiums for the same benefits.  Although the vision discount plans will be cheaper, they will also offer fewer benefits.  

Another thing that needs to be considered is whether or not the patient’s employer is contributing to the cost of the policy.  Also, an employer might make deposits to the patient’s health savings account which would also reduce the cost of services.  

One last thing to consider:  If a person has an eye problem that is actually a medical problem, the vision insurance, and the discount insurance will not pay anything.

When an eye doctor finds a medical problem, the doctor will send the patient to a medical eye doctor.  Then the services will automatically flip over to the person’s health insurance plan.  

Even though this is very complex, it is the only way to figure out if the cost of the policy is cheaper than the cost of the services you will need.

Glasses Online

With the advent of new online services like Warby-Parker and Zenni, it becomes even more difficult to decide whether or not you need vision insurance.

If you are young and only need corrective lenses, no bifocals, or progressives, you can probably get a pair of cheap fashionable glasses from one of the on-line companies.

One on-line company can fill a regular prescription with quality lenses and frames for only $12 to $15 including shipping.  It doesn’t make much sense to pay the huge prices at optical shops even with a discount.  

Seniors

Many people when they retire are surprised to find out that Medicare does not cover vision services.  After years of having help with those costs based on an employer group policy, this can come as a shock.

This is where people end up having to buy an individual vision care policy, whether they choose regular insurance or a discount program.  Seniors on Medicare can purchase Medicare Supplemental policies that can cover vision care.

Although Medicare doesn’t cover eyeglasses, it will help pay for glasses if you need them after cataract surgery.  

Since seniors will most likely need special lenses such as bifocals and trifocals, it might be more cost-effective to buy vision insurance or a discount plan rather than go without.

Also, older people would be more likely to need special eye services.  Luckily, the medical part of Medicare, Part B, does cover testing and treatment of age-related macular degeneration, and diagnosis and treatment of cataracts or glaucoma. 

Below is a discount program, a retail program, and a traditional insurance program to help make the decision. 

Blue Vision 

Blue Vision is a traditional vision insurance program rather than a discount program.  It has been offered by Anthem Blue Cross/Blue Shield for many years.  

It can be added to your Anthem health care or dental plan.  Eye exams cost a $20 copay, lenses cost a $20 copay,  and they give a $130 glasses allowance.  

VSP

VSP is probably the most well-known of the vision discount plan providers. It is not traditional vision insurance.  They are the only vision care discount program that is non-profit. 

VSP is also one of the oldest vision care discount programs.  It was founded in 1955 by a group of eye doctors who wanted to give back to their communities by providing eye care at reasonable prices.

Enrollment is open year-round, they have the largest doctor network, they offer discounts on hearing aids and a free one-year warranty on products. 

Costco

Costco warehouse stores are not an insurance program nor are they a discount plan, but they offer eye care and should be considered when thinking about whether or not to buy vision insurance.

Although patients do not have to be a Costco member to get an inexpensive eye exam, a person does have to join the club in order to purchase glasses and contacts.   

Although the glasses would be less expensive, a patient would need to figure in the cost of the membership when they are considering buying glasses there.

Strong points in their favor:  most consumers are very satisfied with their purchase and most people go back for repeat visits and purchases.  Consumer Reports Magazine rated them the #1 place in America to buy glasses.  

It’s important to make a wise decision if money matters. People who lose their jobs will lose their vision insurance coverage and may need to buy an individual policy. Individual policies will be more expensive than being on a group policy through an employer.   

When making a decision, it is also important to know that most vision discount plans and vision insurance plans don’t cover special lenses like progressive lenses or trifocal lenses.  They usually won’t cover impact-resistant lenses for children, nor do they cover special coatings like anti-glare.