It's no surprise that vision insurance is misunderstood by many people. Depending on the reason for the doctor visit – a routine exam or an eye injury – it’s not always clear which doctor to visit.
At its most basic level, vision insurance helps cover the cost of routine eye exams, contact lenses and glasses. Some vision plans also pay for corrective procedures such as laser eye surgery. Additionally, most plans include one pair of glasses or contacts a year.
Routine vision exams to an optometrists or general ophthalmologists may produce final diagnoses such as nearsightedness, farsightedness or astigmatism. During this exam, the optometrist or general ophthalmologist might detect a problem related to diabetes or some other disease. A medical eye exams may produce a diagnosis such as conjunctivitis (pink eye), a common occurrence among children. Most insurance companies focus on the reason for your visit, so your health insurance probably would not cover a routine eye exam but, a follow up visit to your doctor because of a problem detected during a routine eye exam might very well be covered. Plus, your health insurance probably would cover a doctor visit for an eye disease or eye injury.
Vision care insurance usually covers a percentage of the following basic services:
Your specific vision care plan may have a limit, such as annually or every two years on how often it will pay for lenses and frames.
Frequently, vision care plans (including those you buy or are provided by your employer) contract with eye care professionals. In some plans, you use a certain eye care provider and receive a discount on the services offered. However, most plans purchased from a vision care insurance company are PPOs (preferred provider organizations) where your eye care is managed by a network of eye care providers. In a PPO, you also can use out-of-network eye providers, but you must pay a greater share of the cost.
Typically, eye care offices and networks include optometrists and general ophthalmologists. Some networks also may include ophthalmologists who perform refractive surgery, and provide LASIK or other vision correction procedures.
If you or members of your family wear corrective lenses and need periodic eye exams and changes in your eye lens prescription, it may be worthwhile to purchase vision care insurance. If you do not currently wear or need glasses, you may be able to get a periodic eye exam through your regular health insurance plan.