Do I Need Vision Insurance? | Eyes on the Dollar

One question I get asked frequently  is, “Do I need vision insurance?  Maybe your job offers vision coverage, or you are thinking about adding a rider to your current health insurance plan. Are you having eye problems and think you should have insurance before scheduling an appointment? Maybe you should just go to Cheapskate Eye Care, Hair Salon, and Donut Shop. Don’t they sell glasses? Do I really need vision insurance?

Vision Plans Only Cover the Basics

The honest answer is no. Vision insurance only covers routine testing of your vision to check if you need glasses or not. It usually has some sort of benefit for glasses or contacts.

Vision insurance doesn’t cover medical problems. If you have cataracts, glaucoma, cancer of the eyeball, or have a dagger sticking out of your eye, your vision plan will not help at all. However, if you know you need vision correction and are good about getting regular eye exams, vision insurance could save you some money.

What Does Vision Insurance Cover?

There are way too many types of vision plans to mention them all, but they tend to have several areas in common. Generally, vision plans cover these things.

  • A routine eye exam every 12 to 24 months.
  • Coverage for a basic pair of glasses or an allowance for contacts every 12 to 24 months.
  • Polycarbonate lenses for children under 18. These are the more impact resistant type.
  • Discounts on non-covered products like anti-glare coatings or no line bifocals. Some really good plans might cover options like this, but most charge a separate fee.
  • Many vision plans offer a percentage discount on LASIK surgery with specified surgeons.

But I Never Go to the Doctor

Vision plans are not like health insurance plans. They offer their benefit every cycle. If you don’t use it, you are throwing away money. It kills me to have patients who have vision insurance but only get an exam every five years.

Does Vision Insurance Make Sense for Me?

Just like everything else that takes your hard earned money, you should look at the numbers. For example, most vision plans cost around $10-$20 per month. If yours is $15 per month, you”d be paying $180 per year to have a vision plan. Let’s look at some examples to see if this makes good financial sense.

Example #1: I have perfect vision but have a family history of glaucoma. I want to make sure I’m not developing glaucoma.

This patient would be better off to drop the insurance and pay for an annual exam. In my office, you could get a full exam and do additional retinal screening photos for less than the price of the policy. If you do develop glaucoma, your health insurance would take over from there.

Example #2: My glasses are really nice and expensive so, I try to make them last a long time.  I only get an exam and glasses about every five years.

This patient has a really high prescription and gets all the bells and whistles. I realize prices vary, but let’s use these for this example.

Without Insurance

  • Exam:$145
  • Frame: $150
  • Premium No Line Bifocals: $225
  • Anti-Glare Coating: $100
  • Extra Thin and Light: $100

Total cost of glasses and exam without insurance: $720

With Insurance (Based on the most common plan I see)

  • Exam:$20 copay
  • Frame:$25 copay
  • Premium No Line bifocals:$93
  • Anti-Glare Coating:$72
  • Extra Thin and Light: $40

Total cost of glasses and exam with insurance: $250

It may seem at first like this patient is saving a ton of money, but remember that he only gets and exam and glasses every five years. He is paying $180 a year to keep the plan, so he has really paid $1150 to change his prescription every 5 years. He would be better to save the money and pay out of pocket. If he gets and exam and glasses every year, he would be paying $430 a year with insurance. Every two years would be $610. At year three, it would make more financial sense to just pay out of pocket instead of carrying a vision plan. 

Example #3: I only wear contacts and wouldn’t be caught dead in my glasses.

Without Insurance

    • Exam: $145
    • Contact Lens Fitting Fee: $60
    • Year Supply of Contacts:$200

Total cost without insurance: $405

With Insurance

  • Exam:$20 copay
  • Contact Lens Fitting Fee: $60-15% discount offered by most vision plans=$50.40
  • Year Supply of Contacts: $200-$120 contact lens allowance offered by most vision plans=$80

Total with insurance:$150.40 +$180 per year for vision insurance premiums=$330.40, a savings of about $75 per year.

4 Questions to Answer Before Getting Vision Insurance

I could list a hundred more examples, but to determine if you need vision insurance, there are really four important questions you need to answer.

-How much do I spend annually on vision care and products?

-How much would my premiums cost?

-What does the plan actually cover?

-Is there a provider I like who accepts this vision plan?

If your plan is confusing, ask a provider to give you a cost breakdown. Calling the insurance company often leads to more confusion.

If you do sign up, make sure you use the plan. Paying for years of premiums and never going to the doctor is a great way to waste money. If you will use it and need help with your vision, insurance might be a really smart investment.

What are your experiences with vision plans? If you have one, do you use it? If you don’t live in the US, what is vision care like for you?

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