Vision Insurance

Vision Insurance

If you ask people which of the five senses is most important to them, most will not hesitate to answer: the sense of sight. According to the Centers for Disease Control and Prevention (”CDC”):

“More than 70% of survey respondents from National Eye Health Education Program (NEHEP) 2005 Public Knowledge, Attitudes, and Practices survey consider that the loss of their eyesight would have the greatest impact on their day-to-day life…”

Everyone can appreciate the importance of maintaining healthy vision and taking steps to correct basic visual impairments. The costs that come with maintaining and improving your vision vary significantly depending on whether or not you have vision insurance and which specific plan you select. By working with an independent insurance agent, you can find the right Health Insurance, or more specifically, vision insurance plan for you (and your family). You can save yourself hours of research comparing plans and hundreds or even thousands of dollars every year on eye-related expenditures.

Vision Problems Are Very Common

If you are an American, then odds are you have glasses and/or contacts. According to a 2012 survey, 75% of Americans use some form of corrective lenses (eyeglasses or contact lenses). Even if you don’t currently wear prescription glasses or contacts, the CDC recommends that everyone should get a comprehensive dilated eye examination:

You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don’t realize they could see better with glasses or contact lenses.”

Furthermore, the American Optometric Association (“AOA”) recommends that even a person with no existing visual problems should get an eye exam every two years between ages 18 to 60, and every year after age 60. The AOA recommends annual exams for anyone between 18 and 60 years if they have existing eye problems or an increased risk of problems (e.g. caused by diabetes, hypertension, or a family history of ocular disease). The AOA also has specific detailed recommendations for people younger than 18 years old, which you can find here.

The Most Common Vision Problems

In the Unites States, the most frequent eye problems are called “refractive errors.” The most well-known refractive errors are commonly referred to as near-sightedness (myopia), farsightedness (hyperopia), astigmatism, and presbyopia.

People with myopia can see nearby objects easily, but have difficulty seeing things that are further away. Those with hyperopia have the opposite situation: they see faraway objects easily but distant objects appear blurry. Astigmatism refers to when an eye has an irregular curvature (more like a football than a basketball). People who have astigmatism tend to have different degrees of blurred vision. Presbyopia impairs the eye’s ability to focus on nearby objects, due to an age-related hardening of the lens.

The good news is that all four of the above mentioned vision problems are usually correctable without any surgery. All that is required to fix these problems is a comprehensive eye exam and the use of prescription glasses or contact lenses. However, the cost of fixing these problems can be very high without vision insurance.

The Basics of Vision Insurance

Like medical insurance, vision insurance policies can be obtained either through a group plan or independently. Having vision insurance will entitle you to a range of benefits and/or discounts depending on the specific provider and plan that you choose. Typical vision insurance plans include savings on eyeglasses and/or contacts, as well an annual eye exam from a network of pre-approved eye care professionals. There are two main ways to reduce the cost of eye care and related products: vision benefits packages and vision discount plans. Let’s take a look at how these two options work.

Vision Discount Plans

With a vision discount plan, the participant usually pays an annual membership fee upfront and receives a membership card for the year. The vision discount company has an arrangement in place with a network of eye care providers and eyewear retailers. Under this arrangement, the eye care providers agree to provide certain eye care services at discounted prices to any members of the discount vision plan.

Most vision discount plans include discounts on comprehensive eye exams, contact lenses, and glasses. The level of discount varies depending on the plan, but the typical range for most services and eyewear is between 15% and 25% discounted from the retail price. If a member of a vision discount plan goes to an out-of-network eye care provider, they will probably have to pay the full retail price.

Vision Benefits Packages

Vision benefits packages have a lot in common with vision discount plans, but there are a few key differences. Like discount plans, vision benefits packages usually offer participants access to an annual eye exam, prescription glasses and/or contact lenses from an approved network of eye care providers.

Individuals must pay an annual or monthly premium or fee in order to participate in a vision benefits package. If a benefits package participant goes to an out-of-network provider, the participant should expect to pay the full retail price during the visit to the eye care professional or eyewear store. After the visit, some (but not all) benefits packages will provide a partial reimbursement for out-of-network services or eyewear.

Unlike vision discount plans, vision benefits packages sometimes require participants to pay a deductible. The deductible is a predetermined dollar amount that participants pay before the benefits of the plan kick in.

Some vision benefits packages also require participants to pay a small co-pay for eye care visits or eyewear purchases. The amount of the co-pay will vary depending on the benefits company and the type of service or product, but common co-pays range from $10 to $25 per visit or item.

Benefits Packages vs. Discount Plans

The annual cost to join a vision discount plan is typically lower than the annual premium of a vision benefits package. However, the discount plan member will usually pay 75% to 90% percent of the retail cost for eye related expenses, in contrast with a very low co-pay.

For example, if an eye exam costs $150 retail, then the insurance benefits package participant might pay only $20 as a co-pay, while the discount plan member would probably pay closer to $120 (assuming a 20% discount). As with most things in life, saving money up front can end up costing more in the long run.

Matching Vision Insurance Options With Your Needs

When it comes to choosing a vision insurance company and choosing a specific plan, there are many different options. An independent insurance agent can help sort through these options to find the optimal solution for each individual’s situation. Generally, the costs of vision insurance are impacted by the same factors whether the patient is considering a vision benefits package or a discount plan.

Here are some important questions to keep in mind when choosing a plan:

  • Is the vision insurance part of a group plan (e.g. for employees of a company or school district) or an individual plan? It is generally cheaper to join a group than to buy insurance as an individual.
  • How extensive is the network of approved eye care professionals? Ideally, there should be a good selection of reputable in-network ophthalmologists and optometrists. The eye care offices should also be geographically convenient.
  • What kind of discount or benefits are provided if the patient chooses to get an exam from an out-of-network eye care professional?
  • Can prescription eyewear be purchased anywhere or only specified retail chains?
  • Is there an annual deductible?
  • What are the covered spending limits, co-pay dollar amounts and/or percentage discounts for the following:
    • Comprehensive eye exam (also, what tests are included?)
    • Eyeglass lenses (including specialty lenses if needed)
    • Eyeglass frames
    • Sunglasses
    • Contact lenses (how many refills are allowed per year?)
    • LASIK or other corrective surgeries
  • Will other family members be joining the plan? What are their expected eye care needs?

What Is Included In An Eye Exam?

With a comprehensive eye exam, an eye care professional can detect any refractive errors and determine the appropriate eye wear prescription to correct the problem (e.g. glasses for farsightedness). Not all eye exams include the procedures needed to prescribe contact lenses, which may require a follow up visit.

During a comprehensive eye exam, the eye care professional puts drops in both eyes to dilate the pupils. Dilating the pupils allows the eye care professional to see the back of your eyes and look for signs of injury or disease. Allaboutvision.com provides a good list of what a comprehensive eye exam should include:

  • “A review of your personal and family health history and any history of eye problems
  • Evaluation of your distance and near vision with an eye chart
  • Evaluation for the presence of nearsightedness, farsightedness, astigmatism and presbyopia
  • Near vision testing to determine if you have presbyopia and need progressive lenses or bifocals
  • Evaluation of your eyes’ ability to work together as a team
  • An eye pressure test and examination of the optic nerve to rule out glaucoma
  • Examination of the interior of your eyes to rule out other eye problems, such as cataracts and macular degeneration.”

The cost of a comprehensive eye exam can vary widely depending on the services included, the type of eye care professional (ophthalmologist or optometrist), and most importantly, the patient’s specific vision insurance plan.

Comparing Eye Care Professionals

One area where vision insurance plans vary is in the types of eye care professional that are within coverage. Ophthalmologist, optometrists, or opticians are all called “eye care professionals” but they have different levels of training, different licenses, and different capabilities.

An ophthalmologist is a medical doctor (MD) who has completed post-graduate training to specialize in medical and surgical eye care. Ophthalmologists are qualified to prescribe glasses and contacts, perform eye surgery, and treat eye diseases and conditions.

Optometrists are not medical doctors, but they do have a doctor of optometry (DO) degree. After college, optometrists go to a four year optometry school to obtain their DO status. Optometrists are qualified to prescribe glasses and contacts, as well as vision therapy and medication to treat eye diseases.

Opticians generally fit and repair glasses and provide instruction for proper use and care of contact lenses. Opticians do not perform comprehensive eye exams as described above. Opticians are trained on the job or in technical schools.

Vision Insurance and Medical Insurance

It is important to understand the difference between vision insurance and medical insurance. What is covered by vision insurance is often not covered by medical insurance, and the reverse is also true. Medical insurance can help protect you from the unexpected costs that come with eye injuries and diseases that affect the eyes. Similar to dental insurance, vision insurance should be thought of as a supplement to medical insurance (not a replacement). Vision insurance will reduce the costs of routine eye care visits and eye wear purchases, which could otherwise add up very quickly..

For instance, if you go to an optometrist or ophthalmologists for a routine eye exam, a vision benefits package will cover most or all of the cost. As mentioned above, the most common reasons for a routine eye exam are nearsightedness, farsightedness, astigmatism, and presbyopia.

Your vision insurance plan almost certainly will not cover the visit if the reason for the eye exam is a medical problem. Common medical reasons for an eye exam include: cataracts, conjunctivitis, eye injuries, glaucoma, pink eye, and eye diseases related to diabetes or hypertension.

The distinction between eye exams performed for routine reasons and those performed for medical reasons can lead to some confusing situations. As part of routine eye exams, doctors examine the eyes for nearsightedness, farsightedness, and astigmatism. However, during these routine eye exams, most doctors also check the eyes for other medical conditions such as cataracts, glaucoma, retinal injuries, and hypertensive eye disease. If the doctor discovers a medical condition or disease that requires specific counseling and documentation, ongoing monitoring, or referral to a surgeon, then the visit will probably change from a routine eye exam to a medical exam that will not be covered by most vision discount plans or vision benefits packages.

For example, a patient might schedule a routine eye exam because he thinks he needs to update his glasses prescription for farsightedness. If the doctor’s examination reveals that the patient’s vision is actually impaired due to retinal injuries, the visit will then be considered a medical exam. This patient’s eye exam would likely not be covered by his vision plan, but the exam most likely would be covered by his medical insurance (assuming he has medical insurance).

Vision Insurance and the Affordable Care Act

The Affordable Care Act (ACA) is a federal law that aims to make health care more affordable, increase the number of Americans with health insurance, and improve the quality of health insurance. Under the ACA’s authorization, the Secretary of Health defined a list “essential health benefits” that new insurance plans must provide. One of the essential health benefits is “pediatric services, including oral and vision care.” Although it seems there will be increased access to vision care for children, the ACA and subsequent regulations do not seem to require insurance companies to include vision care for adults in their new plans. Thus the ACA will not necessarily impact the prices of vision insurance for adults.

Conclusion

Vision insurance can be a complex field for most people to navigate, but choosing to go without insurance can be very costly. There are a great variety of plans to match the variety of different household budgets and vision-related needs. Individuals can work with an independent insurance agent to find the right plan and save money every year.

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Enhanced Insurance is not written by attorneys. If you’re looking for legal advice, you need to contact a lawyer. Further, insurance practices and forms change constantly and are varied from state to state. For definitive answers in your area, contact a local agent.

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