Vision insurance is an often overlooked and neglected part of healthcare. However, it can be just as important as your health insurance. Here is everything you need to know about vision insurance so that you can decide if it is necessary for you and your family.
Provider Networks
There are two basic types of organizations that your vision insurance can be linked with. These organizations are called HMOs (or health maintenance organizations) and PPOs (or preferred provider organizations). HMOs are generally cheaper, but they only pay for doctors or services that are in-network. Any out-of-network care must be paid for out of pocket, unless in case of a medical emergency. HMOs also require referrals through a primary care physician before seeing a specialist. PPOs allow for visits to out-of-network physicians but will come with a higher cost. No referrals are needed with a PPO to see specialists or receive services.
Vision insurance can be linked with either of these two options. They can also be connected to an indemnity insurance plan which is a traditional type of plan that allows you to visit whichever doctor that you prefer. The insurance then pays for a certain percentage of the service. Indemnity plans generally cost more than HMOs or PPOs but give greater flexibility.
Vision insurance can also be purchased independently using a vision insurance company. These plans generally look a lot like a PPO, and the purchaser will have the option to see in-network and out-of-network physicians and will usually have to pay a small co-pay at the time of the visit. There are many different vision insurance companies to choose from. If you are planning on purchasing vision insurance independent of other healthcare, be sure that the company you choose has network providers in your area. If you have an optometrist in Denver or an ophthalmologist that you like already, it is a good idea to find an insurance policy that is in-network with this provider.
How to Choose a Plan
If your employer provides vision insurance through your company’s plan, then it may not be necessary to do extensive research. You may simply have to subscribe to the plan that has been provided. However, if you are purchasing insurance independently, it is a good idea to put in the effort to find the best one for your family. There are two different types of plans available for vision. Both are viable options, and the choice can be made by calculating how much you typically spend on vision each year.
For individuals or families who spend a considerable amount of money on glasses, contacts, and other services, Vision Benefits Plans can be the best choice. The monthly premiums for this type of insurance are generally higher, but the insured usually gets more coverage. This type of plan will typically pay for glasses and contacts up to a certain dollar amount. For visits to the optometrist, the insured will pay a small co-pay at the time of the visit. With this type of insurance, the covered individual will pay less for doctors that are in-network, but more for any doctors that are out-of-network.
The other type of vision insurance is called a Discount Vision Plan. This plan may be perfect for someone who does not have to spend very much money per year on their eye health. These individuals may not need glasses or contacts, for example, and simply need to go in for their annual visit. These plans have a much lower premium, but will not cover as high a percentage of the cost of frames, lenses, and office visits. Instead of paying outright, they will offer a discount on whichever product you choose.
It is a good idea to take some time to sit down and find the cost versus benefit. Take into account premiums, co-pays, and deductibles. If the amount you would pay for a vision benefits plan is less than the amount you would spend on eye health, then the more comprehensive plan is definitely worth the money. You should also consider family genetics when choosing a plan. If eye problems run in the family, it is especially important to have good coverage for you and your children and to get an exam every year.
Is Vision Insurance Necessary?
Everyone should be getting a routine eye exam on an annual or biannual basis. This includes individuals who have healthy eyesight and do not need glasses or contacts. All children should have at least one examination by the time they are school age. Because of this, having vision insurance can be just as important as having general health insurance. That being said, vision insurance is not a legal requirement. Some people may find that the cost of paying for a single annual visit every year is actually less than paying the monthly fee. However, if any treatments, glasses, or contacts are needed, the cost per year of insurance is much lower and is worth paying an extra $15 to $18 per month.
What Does Vision Insurance Cover?
Depending on the type of insurance, vision insurance will cover different monetary amounts. However, most insurance policies cover similar items. An eye exam is at the top of this list. Most plans cover one yearly eye exam with a small co-pay. Insurance will also cover frames and contact lenses either with an allowance of a certain dollar amount or by providing a discount. Eyeglass lenses are generally covered with the requirement of another small co-pay yearly. Some providers also offer discounts on other special add-ons to glasses such as transitional lenses or special coatings.
Most insurances will also cover corrective surgeries such as LASIK. The plan will generally provide a discount on these surgeries, generally up to around $500. However, other treatments or surgeries are often considered medical and are covered by the patient’s general health insurance. It is important to note that most policies will not cover additional yearly visits to the optometrist, and basic insurance does not cover lost or broken glasses or fees for missed appointments.
What Are FSAs and HSAs?
FSA stands for “Flexible Spending Account.” Many insurance plans offer FSAs as a benefit to help individuals pay for expected and unexpected medical costs throughout the year. An FSA is an account where you can contribute a certain dollar amount before taxes to be used throughout the year. Generally, an individual can put in up to $2,700 to be used before the end of the year, and all of this money is tax-exempt. It must be used up by the end of the year or it will disappear.
FSA money can be used to purchase a wide variety of things from frames to additional visits or exams. Many individuals use it to purchase a pair of sunglasses in addition to their normal glasses. It can also be used to purchase frames that are outside of the insurance’s allowance amount, as well as special lenses, or contact lenses. There are many other things that can be paid for using an FSA account, so it is always good to check with your own account before paying for something out of pocket.
An HSA is very similar to an FSA. Both are pre-tax and can be used to pay for certain medical expenses. However, they have a few differences. HSAs come with high-deductible health plans. Unlike an FSA, you can keep the funds that are left in the HSA account the next year. The HSA is owned by the individual, while the FSA is owned by the employer. This means that the funds in an HSA can be retained even in the event that the individual changes jobs.
How Much Does Vision Insurance Cost?
When registering for health insurance through your job, you will generally have to make the decision of whether or not to add on vision insurance for family members. It is oftentimes very flexible and can be added for only the family members who need eyeglasses and contacts. The cost per month is different depending on what plan you have. However, most plans can be purchased for less than $20 per month per person.
Where Can I Go to Check My Benefits?
If you find yourself needing to know the specific benefits that come with your insurance plan, it is helpful to know where to go to check these benefits. These benefits can most easily be found online. You can go to your insurance provider’s website and search for a “my benefits” link. If the information is not readily available, call the number on the back of your insurance card and speak with a representative.
If you have not yet purchased vision insurance, now is a great time to do research on the specific benefits connected to your chosen plan. Find out what is covered under the plan you are thinking about purchasing, and see which doctors are in-network with the insurance. If you have the flexibility, compare and contrast several different plans to find out which one has the best combination of price and services. If you know you are going to need certain services in the coming year such as corrective surgery or eyeglasses, make sure these items are covered before purchasing the insurance.
Finally, it is important to review your benefits on a yearly basis. Many companies can change their policies without notifying you, so make it a habit to view these at the beginning of the year so that you are prepared. You never want to be caught off guard when you need a service or a product right away.
Can I Change Vision Insurance?
Open enrollment for most insurance plans occurs at the end of each year. This is typically the time to add or change vision insurance plans. Most plans will not allow you to change or modify your insurance plans in the middle of the year. However, certain events may qualify you to add or change your vision insurance before the next open enrollment. Life changes such as the birth of a new child, the death of a spouse, the loss of a job, marriage, or a divorce may qualify you for a change in policy. You will usually have a grace period of 30 to 60 days to complete these changes. It is important to check your policy to find out if you qualify for any modifications. If not, you will need to wait until the end of the period to make any changes.
Using Your Vision Insurance
If you have vision insurance, one of the best ways that you can maximize your plan is by going in for your annual eye exam. Most insurance policies cover these visits so neglecting this yearly visit is throwing money away. Routine eye exams are crucial for catching diseases and conditions that can affect your vision. You will want to schedule appointments for your children as well, especially if they are school age, to take advantage of your plan’s benefits. You can search for optometrist near me to find one that is in-network with your policy.
Another way you can effectively use your vision insurance is by investing in both contacts and eyeglasses. Insurance companies often pay for both, and it can be extremely convenient to have the option. Many contact wearers choose to have a pair of glasses that they can use while working on the computer, or when they are sick or have allergies and their eyes become more sensitive.
You can use your insurance policy and your FSA or HAS account to purchase multiple pairs of eyeglasses. In addition to regular glasses, many individuals choose to have prescription sunglasses, which can help to protect the eyes while outside, and computer glasses, which can reduce the strain which comes with too much computer use. Check your policy to see which of these is covered.
Although vision insurance is not required by law, it may be a very important addition to your insurance policy. For less than $20 per month, vision insurance can cover a large amount of the costs associated with eyeglasses, contacts, eye exams, and even LASIK surgery. If you are not already covered, now is a perfect time to consider your options.