Are you shopping for individual vision insurance quotes but not sure if you’re getting a good deal? It can be easier once you know what to look for in a stand-alone vision plan. This comprehensive guide has all the facts you need to know about what the best supplemental vision insurance plans should cover, how they work, how to buy them, and how often you should get your eyes checked. Getting an eye exam is not just necessary to keep your vision sharp but to detect if you’re at risk for serious medical conditions. And according to the National Association of Vision Care Plans, you’re twice as likely to visit your eye doctor when you have individual vision insurance.
Eyeglass Insurance for Individuals: What’s It About?
You may hear the terms “eyeglass insurance” and “vision insurance” used to describe the same thing. For the most part, vision insurance provides an affordable option to get preventive care for your eyes through routine exams. If your exam reveals any vision problems that require corrective lenses, a prescription for eyeglasses can be written. So in this sense, you can call it “eyeglass insurance”; however, vision insurance is the official name.
But vision insurance is not just for eyeglasses—plans can help cover the cost of contact lenses. In most cases, plans help pay for the actual contact lenses, not the exam to fit your eyes for contacts. This is because the process of doing a routine exam and a contact lens fitting are different. Although you still get a routine exam when you visit the eye doctor for contacts, the doctor has to perform additional testing to measure the curvature of your eyes (among other things) to make sure that the contact lenses are the right size.
All in all, individual vision insurance gives you a choice— you can use your vision benefits to help pay for eyeglasses or contacts. Plus, it saves you money because you’re not paying for the full costs of eye care and eyewear out-of-pocket.
How Does Vision Insurance Work?
Vision plans typically work through provider networks, and services received at an in-network provider have lower copays. You usually pay copays for exams, lenses, and frames. But depending on your plan provider, you may not be charged a copay for your exam if you stay within the plan’s network. Although you pay a copay, the actual costs of your routine exam and eyewear could be fully covered if you stick to the limits that the plan provides.
Like other types of health-related insurance, the provider bills the insurance company for your visit and you pay your portion of the costs. With vision coverage, a copay is usually the only insurance cost you have when you visit a provider—this does not include your monthly premium that you pay to the insurance company directly or any extra money you may spend at the eye doctor’s office if you want lenses with enhanced features or designer frames.
Vision coverage also works differently depending on the type of insurance plan: indemnity, HMO, or PPO. An indemnity vision plan lets you choose any provider, while an HMO plan provides discount rates for services only when you visit a provider in the plan’s network. A PPO plan also has discount rates for services, but you have the option to visit an out-of-network provider and pay higher rates.
What Do Vision Plans Cover?
Supplemental vision insurance is designed to cover routine eye care services that are not typically provided through health insurance. Major health plans can provide coverage if you need medically necessary eye surgery or have an eye infection or injury. But it does not cover preventive care to check if you need corrective lenses or to maintain your lens prescriptions. Generally, vision plans cover an exam and one pair of eyeglass lenses and frames (or an order of contact lenses) every 12 months. Standard vision benefits include:
- Comprehensive eye exams (contact lens fitting exam usually not included)
- Eyeglass uncoated lenses (single, bifocal, or trifocal vision)
- Eyeglass lenses with coating and enhancements at an extra out-of-pocket cost
- Frames within allowance amount
- Cost of contact lenses in lieu of eyeglass lenses and frames up to allowance amount
How Can I Get Vision Coverage?
One of the main things to know about vision coverage is that there is a difference between how to get eye insurance in general and how you can “buy” an individual or stand-alone eye insurance plan. Many people get vision coverage through their employer, which is often offered as a group insurance benefit. Many also get vision benefits that offer routine care through Medicaid or a Medicare Advantage plan. If you have Medicare Part B (medical insurance), you can get vision care for certain eye diseases, but routine eye exams for corrective lenses are not covered. You may even be able to find a health plan that includes vision benefits for adults through the insurance marketplace; although, marketplace health insurance plans are required to include pediatric vision coverage for kids up to 18 years old.
But when it comes to getting individual vision insurance quotes, you usually have to go through a private insurance company. Private insurance companies sell stand-alone vision plans designed for individual shoppers. Even though you can buy a stand-alone plan as an individual consumer, the plan can include coverage for you, your spouse, and the whole family, which includes your children.
Tips on How to Get the Best Deal for Individual Vision Insurance
Here are some tips to follow that can help make sure you’re getting the best individual vision insurance plan.
- Compare vision insurance quotes from various companies.
- Know what percentage of the exam cost the plan covers and if there is a copay—100% coverage is the most ideal; an average exam copay may be about $15 in-network, but you could find a plan with an in-network copay of $01.
- Find out the copay for standard lenses—your copay may be around $25 on average, but you could get an in-network copay for as little as $101.
- Find out the allowance amount for frames—could be about $120 in-network1.
- Look for plans that have large provider networks that include nationwide retail chains.
- Choose a plan that includes a discount savings program to save money on lenses with enhancements, frames, sunglasses, and even laser corrective surgery (such as LASIK and PRK).
What’s Included in a Routine Eye Exam?
A routine or comprehensive eye exam may include two parts: preliminary testing and the actual exam. Tests check for general eye health, vision impairment, and eye diseases. A staff member or the eye doctor usually takes your medical and vision history before you complete the exam, which may include current medications you take and any eye or health problems in your family.
Preliminary Eye Tests
Before you complete your eye exam with an optometrist, you may do preliminary vision screening with an eye care technician. Tests may check for:
- Color vision
- Depth perception
- Peripheral or side vision
- How your pupils respond to light
- Eye muscle movement to see how well your eyes are aligned and can identify a moving target
The Actual Exam
Private vision insurance covers a comprehensive eye exam that includes a series of tests to check for refractive errors, your overall eye health, and any unusual eye conditions that could be signs of eye diseases. According to the Centers for Disease Control and Prevention, getting an exam where your eyes are dilated is necessary because treatment for eye diseases is most effective when detected in the early stages. A comprehensive eye exam can include:
- Visual acuity testing to measure your vision in each eye. You cover one eye at a time while reading letters on a chart to check how well you can see the largest to the smallest letters. According to the American Optometric Association, seeing at a 20/20 distance means you have normal vision acuity.
- Cover test to check how your eyes work together and how much they move. This involves the doctor covering each eye while you look at a distant target.
- Retinoscopy exam to get an estimate for your lens prescription. During this exam, the optometrist shines a light in your eyes to check how they reflect light and flips through a machine called a phoropter while you stare at a large letter.
- Refraction testing to check for impairment, such as nearsightedness, farsightedness, and astigmatism. You look through a machine while the doctor flips through different lenses and asks you which you can see better through. This provides an accurate reading for your lens prescription.
- Retinal exam, known as an ophthalmoscopy, is done to check the back of your eyes using pupil dilation drops and an ophthalmoscope. This exam can detect problems with your retina and eye diseases.
- Slit lamp testing also checks for eye diseases, but this time the front of your eyes are examined. This machine lights up and magnifies the front of your eyes where parts like your iris, cornea, and lens are located.
How Often Should Kids and Adults Get an Eye Exam?
One of the incentives of getting individual vision insurance quotes to buy a vision plan is that you don’t have to put off going to the eye doctor. Regular exams for the whole family can detect early signs of eye conditions like diabetic eye diseases or amblyopia, which is the most common reason for vision loss among children.
If you’re at risk because of current vision/health problems or family history, then you have even more reason to get your eyes checked at the proper times. Your age range also determines when you should get routine exams. Below are the recommended time frames to get a vision exam by age group and health condition.
Eye Exams by Age Group2
6 months to 5 years old: A child’s first comprehensive eye exam should be done by 6 months of age or at the very least, within the first 2 years of life. The next stage for another exam is at 3 years old.
6 to 18 years old: By age 6, children should get a routine exam before they begin the first grade and then every 2 years afterward until they turn 18 if there are no vision problems. Those with vision impairment or who are at risk should get annual eye exams.
18 to 60 years old: Adults should get an eye exam at least every 2 years for those with no risk of vision impairment and annually for those at risk.
61 and older: Seniors should have a routine eye exam every year regardless of risk.
Eye Exams by Health Condition and Age Group
Diabetes3: Those with type I diabetes should get a comprehensive eye exam the first 5 years within diagnosis and then every year afterward. Those with type II diabetes should get an eye exam immediately upon diagnosis and then annually post diagnosis.
Glaucoma4: At-risk groups, such as African Americans, should get a comprehensive eye exam according to the following age groups as recommended by the American Academy of Ophthalmology.
- 20 to 29 years old: Every 3 to 5 years
- 30 to 64 years old: Every 2 to 4 years
- 65 and older: Every 1 to 2 years
Talking With an Insurance Professional
Researching supplemental vision insurance quotes online offers convenience. But actually speaking with a licensed insurance agent can give you more personalized service and help provide answers to questions you may not have even thought to ask. HealthMarkets agents are here for you 24/7 to make it easy to get the answers you need. Just give us a call at (800) 642-0607 to learn about enrolling in a vision insurance plan today!