VISION INSURANCE COSTS

• Vision insurance covers procedures and costs not covered by your medical insurance.
• It’s worth considering if you are planning for new eyeglasses, regular eye exams, or specialty procedures that would cost more without coverage.
• Vision insurance is different from a vision discount plan. If you don’t have frequent or costly eye care needs, a discount plan may be more cost-effective than insurance. 

If you go to your eye doctor for an annual eye exam and don’t have vision insurance coverage, you may be surprised when handed the bill: $194 is the average cost, nationally.

That’s because health insurance plans — including Original Medicare — typically don’t cover the costs of routine eye exams, eyeglasses and contacts, or other preventative eye care services. Health insurance would likely only cover if you experienced an eye injury or needed vision care related to a medical condition like eye infections or cataracts. This would make it a medical eye exam. 

So, if you’re considering procedures like LASIK (laser-assisted in situ keratomileusis) — which is not considered medically necessary, and so, is not covered by regular health insurance — or getting new eyewear frames, you may want to think about enrolling in what’s called a vision insurance plan to help with costs. 

Vision insurance options include the following: 

• Buying an individual or family plan directly through a health insurance company
• Buying a stand-alone plan from an insurance benefits company 
• Signing up for employer-sponsored vision insurance through your job

What are your vision care needs?

Taking a personal inventory of expected vision care needs in the coming year is a good start in deciding if the cost of vision insurance is worthwhile. 

There are some key questions you should ask yourself:

• Do I need new eyeglasses or contacts every year?
• Do I need bifocals, trifocals, or other lenses that have special prescriptions?
• Is coverage just for myself, two people, or a family?
• Am I thinking about getting an expensive procedure like LASIK?
• How much is the cash price for the eye procedure I’m considering?
• How much would vision insurance save me on the routine eye services or procedures that I’m considering?

Will a vision insurance plan cover your needs?

It depends. Vision insurance does offer: 

• Coverage for eyewear
• Discounts for some laser eye surgeries 
• Allowances to lower the out-of-pocket costs

Out-of-pocket costs may include contacts, frames, and add-ons like anti-glare coating or tinting and UV-protection. Oftentimes, a significant cost with eyeglasses is the prescription for lenses, which can easily be more than the frames themselves. 

Major insurance carriers like Humana, BlueCross BlueShield, and Aetna all offer vision insurance plans as do insurance benefits companies like VSP and EyeMed.

Vision insurance plans should not be confused with a vision discount plan, which is not insurance. Private insurers may also offer this as an option. But unlike vision insurance where there are in-network and out-of-network providers, these discount programs are limited to participating providers who have agreed to accept pre-negotiated, discounted costs for services. 

Sometimes, the program has geographic limitations as well. This type of a la carte program can be expensive if you have frequent visits with multiple services and procedures. However, it may be cost-effective depending on your needs.

What does vision insurance usually cover?

Medical insurance would provide coverage, if say, you experienced an eye-related injury due to an accident. Vision insurance, on the other hand, would provide some type of coverage for preventive and routine eye care and services, ranging from eye exams to eyewear.

How much does vision insurance cost?

Monthly premiums can be as low as $10 per month or more than $30 per month. The cost of vision insurance will vary based on the following factors: 

• Type of benefits (coverage for one person or more)
• Geographic location
• Age

For example, Empire BlueCross Blue Shield’s vision plans cover checkups and eye exams. Copays run $10 and $20.

Empire plans also provide allowances for eyeglasses and contact lenses. For new frames every 1 to 2 years, Empire provides allowances of $130 to $200; and $80 to $200 for contacts during that same period. For lenses, too, members pay small copays up to $20. Eyewear add-ons or upgrades — like anti-reflective coating, bifocals, and designer frames — can step up the out-of-pocket costs. 

Most major insurers offer discounted benefits, allowances, and special savings when visiting in-network doctors. VSP vision plans and EYEMED provide much of the same benefits.

For instance, VSP estimates cost savings of almost $278 with its standard plan, compared to going without its coverage. Additional VSP benefits include:

• Premiums starting at about $20 per month, depending on location
• Exam copaysstarting at $15, and slightly more for contact lenses
• $150 allowances for contacts and frames, meaning the plan will cover costs up to that amount and gives 20% off additional costs over that
• Laser vision discounts
• Out-of-network coverage
• No enrollment fees and can pick billing date

The table below compares three big insurers’ basic plans. For the comparison, we collected information for a single person, no dependents, in the state of Maryland. However, information can change at any time and vary based on where you live. It’s important to do your research and due diligence to get the latest plan information. 

Do I need to see providers in the vision insurance network?

It’s important to check to see if your current doctor is in-network or not. Depending on the vision insurance benefits, you may not get any help covering certain costs if you go out-of-network. Important questions to ask yourself:

• Do I want to use their in-network doctors? 
• Do I already have a doctor I like? 
• If I stick with my current doctor, will insurance cover the cost? 

Is vision insurance worth it for you?

It’s important to weigh the benefits and find out your needs to make sure you are making the most of your dollars. Vision insurance may be worth it if you want:

• Coverage for regular eye exams
• The option of changing your eyewear — whether frames or contacts — on a schedule (every 1 to 2 years) 
• Comfort of knowing not all costs will come out of pocket

According to VSP, the national average cost of an eye exam, frames, and single-vision lenses without vision coverage is $531 — significant when paying yourself.

The bottom line

Vision insurance may be worth the investment in some cases. To decide, it’s important to first take stock of your vision needs, how often they would need to be addressed, and the cost to do that. During the process, make sure you are looking at a vision insurance plan and not a vision discount plan.

Also, the monthly premium for vision insurance is much lower than that of health insurance, and coverage can help you better plan for future expenses associated with eye exams, eyeglasses, and any elective procedures (like LASIK) you may be considering.