Many people wonder if the cost of their prescription glasses is covered by their insurance plan. The answer is that it varies tremendously from plan to plan. Before you pay out of your own pocket for prescription glasses, take a look at your plan to determine whether or not you have vision coverage.
What Most Insurance Plans Cover
Most medical insurance plans cover losses of vision and finances due to eye injury or disease. In other words, if your eye is damaged in a car accident and you require the services of an eye doctor, it will be covered. Most medical insurance plans do not cover typical "wellness" care for your eyes, such as prescription glasses and routine eye exams, unless the plan has a vision insurance policy attached to it.
Adding Vision Insurance
If you are part of a group insurance plan, you may have the option to add vision insurance to your policy. This is usually considered a value-added benefit that is attached to a traditional health insurance structure. Whether you have indemnity health insurance, an HMO, or a PPO, you may have the opportunity to add vision insurance. By adding this coverage, you will be able to access a network of eye care providers and specialists, as well as coverage and discounts on your routine eye care. This usually includes the cost of prescription glasses.
Paying for Vision Insurance
Adding a vision benefits package to your health insurance adds an annual premium amount. You may also have a deductible that you have to meet before the insurance will cover your eye care. Typically, the premium will be an amount up to $144 a year, and the maximum deductible is typically under $40. Each plan is different, so be sure to read the fine print, but you will pay more for this coverage if you pay for your own health insurance. Some companies provide this as part of their overall healthcare benefits, so read your policy to see if you are covered.
In general, those with vision insurance will receive:
- A yearly eye exam
- Eyeglass lenses and frames
- LASIK discounts
Some providers will put limits on their coverage, such as only allowing the insured to get new glasses or contacts every other year. They also may put a limit on the amount they will pay for frames, which means you will pay a little out of your pocket if you want designer frames.
Tips for Using Vision Insurance
Before you schedule an appointment, check with your benefits information packet to see what doctors are covered. Remember, you will need to use a doctor in your network if you want to be covered. If you need to see a doctor who is not in your network, you may still be able to have your prescription glasses covered by filling your prescription elsewhere, but you will have to pay out of pocket for your exam.
When it is time for your eye exam, make sure you talk to your optometrist about your insurance. Most policies require the doctor to seek pre-authorization before they treat you if you are going to be covered. If this is necessary, have the doctor make the necessary calls before your appointment.
When you arrive for your appointment, present your vision insurance card. You will be asked to pay any deductibles or co-pays associated with the coverage you have. After your exam, the doctor or his staff will help you choose frames. If you have limits on the amount you can spend for frames, make sure you are looking at covered options.
If you are lucky enough to have prescription glasses coverage, make sure you take advantage of it as often as you are allowed. This will ensure that you have updated glasses as often as you need them, helping you see the world around you clearly.
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