Supplemental Vision Insurance: 10 Clear Benefits You May Need to See

Thinking you might need supplemental vision insurance to help keep your eyes healthy?

See for yourself…

• About 12 million people age 40 and older in the U.S. have a vision problem.
• About 1 million people are blind.
• And about 11 million more have other types of vision impairments.¹

Starting to get the picture?

Taking care of your eyes before a problem develops or gets worse can be vital. Supplemental vision insurance can help you and your family maintain good eye health by helping to cover the costs.

If your eyesight is not the best, or even if it’s 20/20, an ounce of prevention now can go a long way toward keeping your eyes healthy.

1. Health insurance vs. vision insurance: what’s the difference?

Vision insurance acts as a supplement to your health insurance by providing benefits not covered under your major medical plan.

Here’s how it works…

• You pay a monthly premium to get certain vision benefits (not part of your health insurance) and the plan covers some of the costs of care.
• Vision plans also use provider networks that allow you to pay less by visiting in-network providers.
• Supplement vision insurance plans typically only cover eye care services (usually once every 12 months. And some plans may be every 24 months).

2. Step into my office: see how vision insurance can work a little more clearly

Let’s say you need to check your vision or eye health for prescription glasses.

Here’s how supplemental vision insurance can impact your visit…and your bill.

• Generally, vision coverage will only pay for one exam and eyeglasses for the year.
• You may have to wait until the following 12 or 24 months to update your prescription under the plan.
• Many plans also offer the choice to get contact lenses instead of glasses, but not both during the same benefit period.
• If you want the plan to cover both, you may have to get glasses one year and contact lenses the next. Or, you may get both at one time and pay for either the contacts or eyeglasses out-of-pocket.

3. Understand the 3 types of vision insurance plans and how they work

How your vision coverage works also depends on the type of insurance it’s classified as.

There are three categories for vision insurance.

• Indemnity Health Insurance. A plan under this category allows you to choose your provider.
• Health Maintenance Organization (HMO). This type of coverage gives you access to a network of providers offering discounted rates. You typically need to stay within the plan’s network to get covered care.
• Preferred Provider Organization (PPO). You also get access to discounted rates through a provider network, but you can choose to see a provider outside the network and pay more.

4. Help protect your eyes: 4 different vision insurance plan types

Thinking supplemental vision insurance might be right for you? There’s four main insurance options to help protect your eyes:

Stand-alone vision plan

This is provided through private insurance companies. Employers are not required to offer vision insurance by law. As a result, stand-alone plans can be an affordable option for vision coverage.

• If your employer offers vision coverage, you can choose not to enroll in their plan.
• Instead, you can buy your own, which may offer more benefits or have lower copays.

Health insurance plan

You may be able to get health insurance that includes vision coverage for routine eye care through an employer.

It’s also available through:

• the Marketplace
• a Medicare plan from an insurance company, or…
• Medicaid
• Medicare Advantage for vision care, which is only available from private insurance companies, can cover routine exams lenses, and frames. Vision tests for eye diseases are covered under Medicare Part B, but routine exams for corrective eyeglasses and contact lenses are not.
• Medicaid covers eye care for kids in all states, but only certain states offer this benefit to adults.
• You can also get medically necessary eye care for disease, infection and injury under a private health insurance plan.

Note: Qualified health insurance under the Affordable Care Act must include pediatric vision benefits for children.² Adult vision coverage is not required.

Group vision insurance

This is typically available through an employer, an association or union.

• These organizations may choose to offer their members group benefits.
• State or federal government agencies may also provide group retiree insurance.

Dental and vision bundle

Packaged dental and vision insurance can also be offered as a group benefit:

• through an employer
• from a private insurance company, or…as a member benefit from an association

5. The truth about discount vision services

“Save 20% to 30% on vision care.” That’s a claim you might see for discount vision services.³

But this isn’t exactly vision insurance.

• For a plan to meet the criteria for insurance, there must be an underwritten policy between you and the plan provider. You visit the provider. The provider bills the insurance company. And you pay the amount leftover.

That’s not how discount vision services work. The provider does not bill an insurance company. Instead, you pay the provider directly for the amount leftover after the discount.

6. Help protect your eyes: 4 standard benefits of vision insurance

What does supplemental vision insurance cover?

That’s a good question to know the answer to before you book an appointment, see a doctor…and get a bill.

• A supplemental vision plan can offer contact lenses and eyeglass insurance for individuals, couples and families.
• In addition, vision plans can include a discount program that can save you money on frames, lenses with special enhancements. This can include things like scratch resistance and UV coating, and corrective laser eye procedures like LASIK or PRK.

The standard covered benefits for vision insurance include:³

• Routine eye exams for preventive care
• Uncoated eyeglass lenses (single, bifocal, or trifocal vision)
• Eyeglass frames up to a certain allowance or dollar amount.
• Contact lenses (instead of glasses) up to a specific amount

7. Know when you need an eye exam

Your vision insurance doesn’t do you any good if you don’t use it. Wondering when you should get an eye exam? Here’s what you need to know:⁴

• Kids age 3 and younger. Your child’s doctor will look for potential eye problems during routine check-ups. An additional vision check-up will be done before kindergarten-age to look for other vision problems.
• School-age kids and teens. Your child’s doctor should look for vision problems before kindergarten. After that, regular vision check-ups aren’t necessary, unless a problem develops.
• Get your eyes checked around age 40. Why? That’s when changes to your vision and eye diseases often begin.
• Get your eyes checked every 1 to 2 years after age 60.

You may need more frequent vision care if you:

• Have a family history of vision problems
• Wear glasses or contact lenses
• Have a chronic disease (like diabetes) that increases the risk for vision loss
• Take medications that could effect your vision

8. Why an eye exam can save you a lot more than you think.

If you pay out-of-pocket for vision exams and services, the average cost is:³

• Eye exam: $206
• Single-lens: $114
• Frames: $242

That’s a total of $562. And you have a family, you might pay that much or four times a year, if everyone gets and eye exam and a pair of glasses or contact lenses.

A supplemental vision insurance plan costs an average of $15 to $37 a month (even less expensive plans are available).⁵ And it can save you hundreds of dollars, because you’ll pay a lot less for exams, glasses, or contact lenses.

9. Help prevent serious vision problems and detect chronic health conditions.

You might think getting your eyes checked is just a way to help protect your eyes. Or maybe get contact lenses or glasses if you need them. And vision insurance can make it a little more affordable.

But vision insurance can save you a lot more money than the cost of an exam, prescription glasses or contact lenses.

A vision exam can also detect vision problems and chronic health conditions like:⁶

• Age-related macular degeneration
• Aneurysm
• Brain tumor
• Cataracts
• Certain types of cancer
• Diabetes retinopathy
• Glaucoma
• Heart disease
• High blood pressure
• High cholesterol
• Lupus
• Lyme disease
• Thyroid problmes
• Vascular disease
• Vitamin deficiencies

Detecting vision and health problems early can help save your eyesight, help protect your health and help save you money on health care costs.

10. Why getting an eye exam can be cost effective

Have you been putting off an eye exam?

Maybe you don’t have vision insurance. Maybe making an appointment is inconvenient.

Or maybe you’re worried about how much you’ll have to pay, even if you have supplemental vision insurance.

Here’s another way to look at the cost of vision insurance and eye exams:¹

• An estimated 93 million adults in the United States are at high risk for serious vision loss, but only half have visited an eye doctor in the past 12 months.
• The annual economic impact of major vision problems among the adult population 40 years and older is more than $145 billion.

Is this you? Getting supplemental vision insurance and routine eye exams can help with your sight, your health and your pocketbook.

Want to get clear on supplemental vision insurance?

We can help. Call HealthMarkets today at (800) 827-9990, or find a local licensed insurance agent and we’ll help you find a vision plan that works for you.