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A Consumer Guide to Vision Coverage

Once you enroll in a vision insurance or discount plan, find out exactly what your benefits are, how much you must pay for services out-of-pocket and what eye care professionals and clinics are on the plan's list of network providers. Understanding the details of your vision insurance coverage can help you maximize your benefits and minimize your out-of-pocket expenses.

  1. Plan Types

    • Vision insurance plans are available through employers or directly from an insurance company. Although many plans offer consumers a vision benefits package, others offer discounts on eye exams and eyewear. You usually have to remit a copay at the time of service or when ordering corrective lenses. The insurance plan then pays the provider the remainder of the cost. Consumers who are members of a discount vision plan pay for eye exams and eyewear in full, but at a discounted cost.

    Know Your Plan

    • Once you enroll in a vision insurance plan, find out to what services you are entitled to and any associated out-of-pocket costs. In many cases, you will need to pay a deductible before your policy begins to payout for eye care expenses. Some plans will charge a copay for each service you receive. Depending on the limits of your policy, you may only have a set number of eye care visits or monetary amount you can use or spend per year.

    Out-of-Network Providers

    • Some vision insurance plans will allow you to use the services of an out-of-network provider. In many cases, the insurance company will still need to approve the provider before you can receive reimbursement for any of the cost. The provider may need to request preauthorization from the insurance company before rendering services. Find out beforehand the procedure for requesting reimbursement if you schedule an appointment with an out-of-network provider. The vision plan should also be able to tell you how much reimburesemtn you can expect for each service you receive. Typically, you will pay more for an out-of-network eye care specialist than you would for an in-network provider.

    Medicare Vision Benefits

    • Individuals who are age 65 and older may receive some vision care benefits under Medicare. If vision problems are the result of a medical condition or caused by some sort of trauma, Medicare Part A may cover part of the cost. Medicare Part B covers its portion of the costs for doctor visits related to eye diseases not covered under Part A. Neither Medicare Part A or Part B covers the cost of routine eye exams. Medicare beneficiaries who have diabetes or a family history of glaucoma qualify for an annual glaucoma screening. Medicare will cover the cost of cataract surgery and the cost of intraocular lenses following surgery.

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