Vision Insurance FAQ

Vision Insurance FAQ

What is vision insurance?
What is a vision discount plan?
Are vision plans ACA-compliant?
Who should get vision insurance?
How much does vision insurance cost?
What does vision insurance cover?
How does vision insurance work?
Will vision insurance cover services only for in-network providers?
Is there an annual maximum limit to vision coverage?
When can you get a vision plan?

What is vision insurance?

Vision insurance is designed to help you pay for routine eye exams and prescription eyewear such as corrective glasses or contact lenses. Some vision plans may even provide a discount or coverage benefit for laser eye surgery.[1]

Vision coverage can be offered as part of a medical insurance policy[2] or as a stand-alone insurance plan.[3] Similar to other types of health-related insurance, vision insurance may specify how often within a benefit period certain services or vision-related products may be covered.

For example, an eye exam may be covered at no charge to you on an annual basis, while you may receive a frame allowance annually or every two years.[4]

This type of benefit is important because regular eye exams can identify eye diseases or injuries, helping you maintain your eye health and preserving your vision.[5]

What is a vision discount plan?

A vision discount plan[6] is not vision insurance. Instead, you pay a monthly or yearly membership fee and in return, you receive reduced fees from participating providers each time you receive certain vision-related services and products, such as eye exams, corrective lenses, and in some cases, even LASIK surgery.

If you don’t need regular vision care or products, a vision discount plan might meet your needs.

Are vision plans ACA-compliant?

No, vision plans are not qualified health plans under the terms of the ACA.

However, the Affordable Care Act (ACA) lists vision coverage as an essential health benefit for children under age 19.[7] Vision screening is considered preventive care, which means that it is covered under ACA plans at no charge for your child.[8]

The specific vision coverage benefits provided for your child depends on where you live and the plan you purchase. Some states’ “benchmark” ACA plans include pediatric vision benefits, while in other states, vision coverage for children is provided by the Federal Employee Dental and Vision Insurance Plan (FEDVIP) or the state’s Children’s Health Insurance Program.[9]

This means that your child may be covered for eye exams or corrective lenses, either at no charge or with these benefits subject to copays, coinsurance, or deductibles.[10] Be sure to check your plan for specific details.

The ACA does not consider vision coverage to be an essential health benefit for adults age 18 and over, so plans are not required to include vision coverage for adults.[11] If your plan does not include vision coverage, a stand-alone vision insurance plan may meet your needs.

Learn more about ACA vision coverage.

Who should get vision insurance?

The Vision Impact Institute estimates that 75% of Americans require vision correction.[12] If you regularly access vision care services, need eyeglasses or corrective lenses, you may find vision insurance helpful for reducing your share of these expenses.

Even if you have perfect eyesight, vision coverage may help reduce your expenses for costly annual eye exams, which are important for screening for changes to your eyesight or identifying any ocular health issues.

How much does vision insurance cost?

Vision insurance premiums are typically calculated based on factors such as:

  • The plan design (what’s covered, and your co-pay structure)
  • Where you live
  • How many people are covered under the plan

To find out what vision insurance could cost you, get quotes online or call 888-855-6837 to speak with a licensed agent.

What does vision insurance cover?

The services covered by vision insurance depends on the specific plan you purchase. But in general, you’ll receive benefits for vision exams, corrective lenses (glasses or contacts), and eyeglass frames.[13]

Some plans may provide benefits for refractive surgery (such as LASIK), while others may not, considering such surgery to be cosmetic (medically unnecessary).[14]

Be sure to read the documents for any plan you’re considering, for details on what is covered and what is excluded.

How does vision insurance work?

When you purchase vision insurance, you will pay a monthly or annual premium to receive benefits for vision care services and products. In addition to your premium, vision insurance typically includes cost-sharing in the form of deductibles, copays, and coinsurance.[15] Your plan may have a waiting period before you can receive benefits.[16]

Stand-alone vision insurance plans generally provide no-cost eye care services and eyewear at fixed dollar amounts. Depending on your plan’s provisions, you may have a co-pay each time you use the plan’s services.

Will vision insurance cover services only for in-network providers?

Depending on your plan, you may be required to receive services from a designated network provider.[17] Be sure to check your plan’s provisions.

Is there an annual maximum limit to vision coverage?

Vision insurance may limit benefits, such as specifying that eye exams are covered once per year,[18] or provide a fixed dollar amount that you will be charged for corrective glasses or contact lenses.[19]

When can you get a vision plan?

There is no official enrollment period for vision insurance, so you can enroll in coverage at any time. You are generally eligible to purchase vision insurance even if you have a pre-existing condition, however, that condition may not be covered.[20]

Call 888-855-6837 for more details about vision coverage.

Independence American Insurance Company and/or Madison National Life Insurance Company, Inc. may underwrite the products referenced on this website. Legal Disclaimers.

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