What Is Vision Insurance & How Does It Work?

It probably doesn’t surprise you that visions conditions are common. But did you know that in the U.S., 79% of adults use a form of vision correction, including eyeglasses, prescription sunglasses, reading glasses, and contact lenses?¹ 

It’s easy to overlook routine eye exams. Vision changes are usually gradual, so many of us don’t even take notice until they interfere with our daily lives. However, routine eye exams not only assess your vision and check for eye disease, but much like routine medical and dental exams, they can also help detect diseases (e.g., diabetes and glaucoma) even if you have perfect vision.²

Although it’s hard to put a price tag on the importance of clear, healthy vision, the cost of vision exams, corrective lenses, and other vision treatments can add up – especially for families. That’s where vision insurance can help. 

Vision insurance plans can help reduce the cost of routine preventive eye care (eye exams) and prescription eyewear (glasses and contact lenses). Some plans offer discounts on elective vision correction surgery, such as LASIK. Vision insurance can help you save on vision services. Let’s see how it works and explore some coverage options.

How does vision insurance work?

Vision insurance is a type of insurance that can help you manage the costs of eye care and eyewear. It provides coverage for various vision-related services and treatments, such as routine eye exams, glasses, and contact lenses — helping to reduce out-of-pocket expenses. In addition to individual coverage, many vision insurance policies have family plans that offer coverage to your dependents.

Most vision insurance plans require monthly or annual premiums paid to an insurance provider. Monthly rates are typically less than the cost of a medium coffee once a week.³

Vision insurance terms and definitions

Similar to other types of insurance, your vision plan may include cost sharing factors, such as a copayments and allowances.

Copayments are fixed fees you pay at the time of receiving a specific service, such as an eye exam or contact lens fitting.

Allowance is the amount your insurance provides toward the cost of your eye exam or eyewear. 

Cost sharing factors can vary depending on if you have a vision insurance plan or a vision discount plan (more on this below). Carefully review your plan details or speak with your employer to learn how premiums and cost sharing work for your particular plan.

What are the different types of vision insurance?

Vision insurance typically falls into one of two categories: vision benefits plans (simply referred to as vision insurance) and vision discount plans.

Vision benefits plans

Vision benefits plans are standard insurance plans offered through employers or other groups.A vision benefits plan can also often be included with preferred provider organizations (PPOs) or health maintenance organizations (HMOs).

• Vision PPOs: These plans allow you to visit an in-network provider of your choice. They may also provide coverage for out-of-network providers. You’ll pay lower out-of-pocket costs when you visit an in-network provider, though.
• Vision HMOs: These plans provide access to in-network eye doctors and specialists, but, you’ll have to choose a primary care physician to coordinate care. These plans typically have lower premiums than PPO plans. 

Vision discount plans

Unlike traditional vision insurance plans, you pay discounted fees for covered exams and eyewear. 

When choosing between a vision benefits plan and a vision discount plan, consider your eye care needs and preferences. Vision benefit plans offer more comprehensive coverage and substantial benefits for those who need or anticipate frequent vision care. On the other hand, vision discount may be better suited for those with fewer vision needs.

What are the benefits of having vision insurance?

Vision insurance can save you money on essential vision services. But even if you don’t currently have vision issues, vision insurance may still be worthwhile. Annual exams can help keep your vision sharp and identify potential problems.

Other potential benefits of vision insurance may include: 

• Access to eye care services while reducing the financial burden on individuals
• Regular eye checkups, which can help detect eye-related issues or signs of underlying health conditions²
• Potential savings on eyewear, such as frames and lenses
• Potential savings on lens coatings, corrective surgery, and more
• Family plans that extend coverage to dependents

What does vision insurance cover?

Vision insurance typically covers the following basic services and products:

• Comprehensive eye exam
•  Prescription eyewear (contact lenses or glasses)

Some plans may also offer coverage or potential savings on additional services and products, such as:

• Eyeglass lens enhancement options — e.g., anti-reflective, UV, or scratch-resistant coatings
• Prescription sunglasses
• Progressive or transitional lenses
• Laser vision correction — e.g., LASIK or photorefractive keratectomy (PRK)

These benefits can vary by insurance provider, so check your plan details to learn what it covers.

What does vision insurance not cover?

Vision insurance typically doesn’t cover eye problems and treatments that are considered a medical condition.⁴ This may include eye diseases, such as glaucoma and cataracts, or conditions like eye floaters or dry eyes. However, treatments for eye injuries, illness, or infections may be covered by your health insurance policy.

 Depending on the plan, some coverage exclusions may include:

• More than one eye exam per year
• Non-prescription glasses and contacts
• Cost of frames and lenses beyond the allowance
• Major medical treatments or surgery (these may be covered by health insurance instead)
• Prescription or non-prescription medications
• Missed appointments
• Any services and/or materials not specifically indicated in the schedule of benefits as being covered

Again, it’s important to consult with your plan provider to determine what is and isn’t covered, as coverage can vary.