Vision Insurance

Major medical health plans will generally cover eye diseases such as glaucoma, cataracts, and macular degeneration, with the same cost-sharing that applies to any other illness. But most health plans do not include coverage for routine vision care such as eye exams, glasses, or contacts.

If you have individual/family or small-group health coverage that took effect in 2014 or later, the coverage will include routine vision care for children. (In most cases, the coverage includes one eye exam and one set of glasses per year.) This is because pediatric vision care is an essential health benefit under the ACA^[0]. (Large-group plans are not subject to essential health benefit rules.) Adult vision coverage is not considered an essential benefit under the ACA, so although some major medical health plans do include routine vision care for adults, this is not required and often not included.

Premiums, co-pays and coverage options all vary based on the insurance company and level of benefits you select.

Each vision plan is different, so consider your current and future eye care needs to determine the level of coverage that best meets your needs and budget. If you already have an eye doctor, check to see if they are in the plan’s network, if applicable, to keep costs lower.

Everyone can receive an annual eye exam, regardless of their vision. Vision insurance for individuals and families may be particularly helpful for those with compromised vision, and for older adults. Vision insurance may be a good option for covering the costs of annual screenings and corrective lenses (glasses or contacts).

A routine eye exam is a preventative measure for maintaining your overall health and wellness. Your doctor can screen for vision problems and signs of serious medical conditions such as glaucoma, cataracts, diabetes, and even cancer. Examinations also help determine the right prescription strength for eyewear and contact lenses.