5 Things to Consider Before Getting Vision Coverage
You don’t need to be farsighted—or nearsighted, for that matter—to realize that having a vision insurance plan could help you avoid a lot of future healthcare headaches. But you might be surprised to learn that more than half of American adults did not seek out eye care because of lack of awareness and cost, which is often worsened by them not having adequate health insurance, according to the Centers for Disease Control and Prevention (CDC).
And that’s not a good thing, especially when it comes to your overall health. Case in point: Of the roughly 93 million Americans high risk of vision loss, only half have seen an eye doctor in the past 12 months, also per the CDC.
“I actually had an experience in my human resources career where an employee who was just about 40 or so found out through their annual eye exam that they were very close to developing glaucoma,” says Yuletta Pringle, a human resources knowledge adviser for the Society for Human Resource Management, based in Alexandria, Virginia.
Even if you have health insurance coverage, it’s possible that your plan doesn’t cover your eyes—at least in a general sense. That’s because your regular health insurance plan might not offer routine eye exams unless both or one of your eyes gets injured (think: a branch pokes you in the eye) or you have a chronic eye-related medical condition (glaucoma, for example).
That’s where vision insurance comes in handy. For around $10 to $20 a month, you’ll usually get an eye exam every year, along with coverage for eyeglasses or contact lenses (or sometimes both).
1. Who’s in network for me, and how close are my providers?
Most plans list the vision care specialists (i.e., optometrists) or eyeglass shops that are considered in network, which will be easier on your wallet than out-of-network ones, simply because they’re covered by that plan.
So it pays to search for providers that might be at a convenient distance from your home or whom you’ve seen in the past and are familiar with.
“If I already had an optometrist that I’ve been going to, I would see what networks they’re in,” says Brett Casey, a licensed insurance agent and executive sales leader in Oklahoma City. If you don’t have a regular eye doctor, check to see how many providers are close to you, especially if you’re in a rural area.
“People in rural areas will buy a vision plan, and they might find out that the closest eye doctor is 120 miles away,” Casey notes. You can search by a doctor’s name or by doctors within a 5- to 10-mile radius to see which in-network providers are nearest to you.
Contact a HealthMarkets licensed insurance agent at (800) 827-9990 for more information.
2. What’s it going to cost me?
Vision plans vary in price, so you’ll want to know whether you’re getting your money’s worth.
A good place to start? Look at the monthly premium—how much you’ll be paying for the vision plan—and jot down what you think you’ll be getting out of the plan, says Casey.
To do that, you need to have a grasp of what your out-of-pocket expenses will look like, says Pringle. Figure that out, plus your monthly premiums or payroll deductions, if your job offers a vision plan. Next, add in your potential copays (what you’d pay at the office per visit), as well as any additional costs for new eyeglass frames or a year’s worth of contacts.
Make sure you take into account any special features you’re looking for, like daily-wear lenses or those celebrity-endorsed designer frames you’ve always wanted.
3. What does my plan cover?
If you wear both glasses and contacts, you’ll probably want to purchase a plan that helps you pay for both in the same year, says Casey.
Some plans cover one or the other in alternating years, which may mean you’ll have to wait an entire year before getting new glasses frames or prescription lenses—or you’ll have to pay more out of pocket to get both.
You’ll also want to know what type of lenses you’ll need in your glasses. Bifocals or progressive lenses can be more expensive than regular ones.
You could also consider getting nationwide vision coverage, says Pringle, so that if you’re on vacation and you lose your glasses in the ocean, it’ll be easy enough to pop into an optical shop wherever you are and pick out a replacement pair.
4. What will customer service be like for me?
It may not sound like an important question to ask yourself off the bat, but do you really want the added stress of not having easy access to actual human beings who can answer questions and help you?
“That’s important because you may have questions about coverage,” Pringle notes. If your plan offers limited customer-service options, you may find yourself on hold a lot or constantly waiting to talk to a real person.
5. How do I get reimbursed?
With some vision plans, you may have to pay the provider first and then submit a claim to get reimbursed. This is especially true if you see an out-of-network provider.
So what’s that process like? Pringle says it’s all in the details: Can you easily submit a claim for reimbursement online or scan your receipts for out-of-pocket expenses? Or will you have to do it by mail or fax?
You may ultimately opt to choose the most convenient option.
After you’ve answered all of these questions, go ahead and pick your vision plan. Remember, vision coverage is worth it even if you don’t need glasses or contacts. That yearly exam could help you keep an eye on your overall ocular health.