While some ACA Marketplace major medical plans include vision coverage for adults (though it’s not required), stand-alone vision insurance plans are not available directly from the federal or state marketplaces.[0]
So, if you want vision coverage, you’ll have to look towards a private health insurance provider.[1]
But is private vision insurance worth it? A vision plan shares the costs of regular maintenance, like eye exams, glasses, and contacts – but do the savings outweigh the cost of the plan?
What Vision Insurance Typically Covers
Vision insurance plans typically cover some of the cost of an annual eye exam, glasses or contacts, and a certain portion of eyeglass frames and lens enhancements (lightweight or anti-glare lenses).[2] Some plans also include discounts for elective procedures, like LASIK surgery.[3]
While most health or dental insurance benefits are covered on a yearly basis, all vision benefits are not necessarily available every 12 months. Some, such as new glasses, might be covered only every 24 months. Also, some plans will only cover glasses OR contacts, but not both during the same period.[4]
Vision plans typically will not cover the costs of eye surgery, treatment of eye diseases (cataracts, glaucoma, macular degeneration) and permanent vision impairment. It is more likely that those conditions would be covered by your major medical plan.[5]
How Much is Vision Insurance?
If you don’t have access to vision insurance through an employer-sponsored plan, how much does an individual vision insurance policy cost? You might be able to find a plan for less than $20 per month for an individual[6] or around $40 for a family. In addition to the monthly premiums, vision insurance plans also typically include a deductible and copays.[7]
Some vision care plans require you to see a provider in the plan’s network. Others only require you to be treated by an optometrist or an ophthalmologist.[8]
Still, you may pay a portion of costs for visits, exams, and glasses or contacts. As is typical of most types of insurance, the higher the monthly premium, the less you’ll pay out of pocket.[9]
Is Vision Insurance Right for You?
If you’re younger, have perfect vision, no history of eye diseases in your family, and no other chronic health conditions that could result in vision impairment (such as diabetes) the cost of an annual eye exam alone may not justify the premiums of a vision insurance plan. However, if you need glasses, contacts or corrective surgery the cost of vision insurance may be worth it.
The average cost of a comprehensive eye exam varies, but without health insurance, it’s around $163,[10] which may be less than you’re paying in yearly premiums. But add in a pair of glasses (frames and lenses) every other year and the out-of-pocket costs can be another $200-300.[11]
As of 2015 (the most recent year for which data was available), 12.4 million people in the U.S. had some form of vision loss or impairment (blindness, near or far-sightedness). That accounts for about 3.8% of the population.[12]
As you age you’re at a greater risk for experiencing vision impairment and may need additional vision care. In fact, vision impairment and blindness in the U.S. is expected to double by 2050 as the youngest of the baby boomers hit age 65 around 2029.[13] Since advanced age is a key risk factor for age-related eye diseases, the greatest burden of vision loss and blindness will impact those 80 years old or older.[14]
Ultimately, you’re the only person that can decide if vision insurance is worth it for you or not.
Alternatives to Vision Insurance
If vision coverage just doesn’t make sense for you financially, there are other options you can consider.
Vision Discount Plan
If you won’t be able to fully use your vision benefits, you may want to look into a vision discount plan instead. By paying a monthly or annual fee, you become eligible for discounted rates for services you obtain from participating providers.
Unlike insurance, you pay the service provider directly rather than submitting a claim through an insurance company, and there are no deductibles, copays or coinsurance.
Health Savings Account or Flexible Spending Account
If you have a Health Savings Account (HSA) or a Flexible Spending Account (FSA) you will likely be able to use those dollars for vision-related care and costs, including:
- Routine eye exams
- Prescription eyeglasses
- Contact lenses
- Prescription sunglasses[15]
Make sure to validate what your FSA or HSA will cover before you obtain vision services.
Pay Out-of-Pocket
As previously mentioned, depending on the level of vision care and services you need, you may just choose to pay 100% out of pocket. That doesn’t mean you have to pay cash. Like most healthcare services, you can typically use your credit card to pay for eye exams, glasses, and LASIK surgery. Just make sure to find out what forms of payment are accepted by your vision care provider first.
Whether you use vision insurance, HSA or FSA dollars, or finance on a credit card, there are more options available (and greater convenience) now than ever before to obtain discounted eyeglasses and contact lenses online to help mitigate your out-of-pocket expenses.
Summary + Next Steps
Costs for vision plans are relatively low. Vision insurance may be worth it if you:
- Are an older adult that requires more vision care
- Have children that need glasses
- Need glasses or contacts yourself
- Have a family history of eye disease, or a condition that increases your risk for eye diseases, such as diabetes[16]
Alternatives such as a vision discount plan, HSA or FSA dollars, or paying out of pocket may make financial sense if you have good vision and don’t require glasses, contacts or corrective surgery.
Have questions? Call (888) 855-6837 to speak with an agent to discuss your options for supplemental insurance.
