Is vision insurance worth it? For most people who wear glasses or contacts, yes. Vision insurance benefits usually include a routine eye exam plus a yearly or every-other-year allowance toward glasses or contact lenses. Most medical plans, by contrast, treat eye disease and injuries but skip routine exams and eyewear for adults. So if you or your kids wear glasses, a vision plan can turn big optical bills into small, predictable ones.
- HealthCare.gov says all Marketplace plans include vision coverage for children, but only some include it for adults.
- Pediatric vision care is an essential health benefit, while adult vision care is not.
- The American Optometric Association recommends an eye exam at least every two years for low-risk adults 18 to 64, and yearly at 65 and up.
- Glaucoma has no early symptoms, and as many as half of people who have it don't know it, according to the National Eye Institute.
Is Vision Insurance Worth It?
Usually, yes, if someone in your home wears glasses or contacts. The math is simple. First, add up a yearly exam, new lenses and frames. Then compare that total with a year of premiums.
Here's an example using UnitedHealthcare VisionWise network benefits. The exam costs $0, and lenses cost a $10 copay. Plus, the plan pays up to $150 toward frames. So one pair of glasses a year can use most of the benefit right away.
- You or your kids wear glasses or contacts
- You want a yearly eye exam without a big bill
- Your health plan doesn't include adult vision care
- You don't wear glasses and only want an exam every two years
- A job or Medicaid plan already covers your routine eye care
- You're planning LASIK, which most vision plans exclude
Still, prices vary by age and ZIP code. So compare a real quote with your expected eyewear costs. Our United Healthcare vision insurance guide and vision insurance coverage page show plan options. You can also call 888-730-6031 for free help.
What vision insurance benefits usually cover
HealthCare.gov defines vision coverage as a benefit that at least partly pays for eye care, like exams and glasses. Beyond that, each carrier builds its own plan. Still, most plans share the same core pieces.
- A routine eye exam, usually for a set copay
- An allowance toward frames, or toward contacts instead
- Prescription lenses, often with a set copay
- Also, discounts on lens add-ons such as coatings
- Treatment for eye disease, which your medical plan handles
- Non-prescription sunglasses
- Laser surgery in full, although some plans offer a discount
Plans often reset each benefit on its own schedule. For example, the exam may renew every 12 months, while the frame allowance renews every 24 months. So read the frequency line for each benefit before you buy.
Lens upgrades and extra vision benefits
Many plans pay for basic single-vision lenses, then charge a set copay for upgrades. For example, progressive lenses, anti-reflective coatings and photochromic lenses often cost extra. Some plans also give a discount on a second pair. So if you need progressives, compare the upgrade copays, not just the frame allowance.
Vision plan vs medical plan: who pays for what
This is the question we hear most. Your health plan and your vision plan cover different kinds of eye care. In other words, one pays for problems and the other pays for routine checks and eyewear.
- Eye injuries and infections
- Treatment for conditions like glaucoma
- Specialist visits for eye disease
- Yearly or every-other-year eye exams
- Glasses or contacts allowance
- Discounts on lens upgrades
Since adult vision isn't an essential health benefit, most adults need a separate plan to get vision insurance benefits. To see where medical coverage stops, read what medical plans cover and skip.
When both plans come into play
Sometimes one visit touches both plans. For instance, you might go in for a routine exam, and the doctor finds signs of an eye condition. In that case, follow-up care for the condition usually goes to your medical plan. Therefore, ask the office which plan it will bill before your visit, and bring both ID cards.
How often to use your vision benefits for an exam
Routine exams matter even if you see well. The American Optometric Association says a quick vision screening can't replace a full eye exam. That's because screenings often test distance vision only, so they can miss real problems.
Those are AOA guidelines for low-risk people. However, at-risk adults, such as people with diabetes, should go at least once a year or as their doctor advises.
In addition, the CDC reports that only half of those high-risk adults saw an eye doctor in the past year. So a plan that makes exams cheap can help you keep up. If you manage diabetes, also see our coverage tips for people with diabetes.
A licensed Vivna agent can compare exam copays, eyewear allowances and eye doctor networks for you, at no cost.
How eyewear allowances work
An allowance is the most the plan pays toward frames or contacts in a benefit period. If you pick something that costs more, you pay the difference. Some plans also take a discount off the amount over the allowance.
Worked example: new glasses
Say your plan has a $10 exam copay and a $150 frame allowance (sample figures). You pick $230 frames. So the plan pays $150, and you pay the $80 difference. Next, add a lens copay, such as $25. As a result, your total for the visit comes to $115.
Without a plan, you would pay the full exam, frame and lens prices yourself. That's why vision insurance benefits pay off fastest for people who buy glasses or contacts often.
Most plans make you choose between glasses and contacts in the same benefit period. Also, out-of-network visits usually pay back only a set amount. Check both rules before you order eyewear.
Making vision insurance benefits last
Track the date each benefit renews, and book your exam soon after. Then use the eyewear allowance in the same period, because unused amounts usually don't roll over. Also, ask whether the plan works with online retailers, since that can stretch your allowance further.
Eye care coverage for kids
On HealthCare.gov, kids get vision care built in. Pediatric services, including vision care, are one of the essential health benefits. In fact, all Marketplace health plans include vision coverage for children.
Even so, check what the plan actually pays for, such as glasses frequency and the frame choices. Meanwhile, the AOA recommends a child's eye exam before first grade and every year after that. For the full picture, see health plans that cover your kids.
Who gets the most from vision insurance benefits?
Almost anyone can use a yearly exam. Still, some people get much more value than others.
You'll likely use the exam and the allowance every period, so a plan often pays for itself.
Yearly exams matter, so pair a vision plan with strong medical coverage.
Check child vision coverage in your health plan first, then fill any gaps.
A discount plan or paying cash every two years may cost less.
How to compare vision plan coverage
Comparing vision plans takes about 10 minutes when you know what to look for. First, confirm your eye doctor with our guide on how to check if a doctor is in network. Then follow these steps.
- Check the network
Search for your eye doctor and nearby optical stores.
- Compare the allowances
Line up frame and contact amounts, plus lens copays.
- Note the frequency
Then see how often each benefit renews, either 12 or 24 months.
- Price the full year
Finally, add premiums to what you'd pay out of pocket.
Vivna compares vision plans from carriers such as UnitedHealthcare dental, vision and medical plans, Aflac's vision and supplemental products and Aetna. When you're ready, compare individual vision insurance plans or plans that pair dental and vision.
Bring your current glasses prescription and the name of your eye doctor when you call. With those two details, we can check the network and show which plan gives you the most for your next pair. Also, ask us to compare a bundled dental plan at the same time.
Mistakes we see on the phones
- Buying a plan before checking the eye doctor network
- Comparing premiums but ignoring lens upgrade copays
- Letting the allowance expire unused each period
- Paying twice for kids already covered by the health plan
Use your exam every period, even when your eyes feel fine.The vision rule our licensed agents repeat most
Buying dental too? Read what dental plans pay per service and what to weigh when you buy all three. Or call a licensed Vivna agent at 888-730-6031.
Vision benefits: FAQs
What do vision insurance benefits include?
Most vision plans include a routine eye exam, an allowance toward frames or contacts, and set copays for prescription lenses. Many also offer discounts on lens add-ons. However, each benefit can renew on a different schedule, such as 12 or 24 months. So check the plan summary for the exact amounts and how often you can use them.
Does vision insurance cover LASIK?
Usually not in full. Laser vision surgery is generally an elective procedure, so most vision plans don't pay for it as a regular benefit. Instead, some plans offer a discount at participating providers. If LASIK matters to you, ask your agent which plans include a surgery discount before you enroll.
Is vision insurance worth it if I don't wear glasses?
It depends on your risk. Low-risk adults 18 to 64 may only need an exam every two years, according to the AOA. In that case, paying cash could cost less. However, if you have diabetes or a family history of eye disease, regular exams matter more, so a plan can make sense.
Does health insurance cover eye exams?
For children, yes. All Marketplace health plans include vision coverage for kids. For adults, only some plans include it, since adult vision isn't an essential health benefit. Medical plans do usually pay for eye injuries and disease. Our full list of eye exam answers covers more cases.
Can my whole family share one vision plan?
Many carriers offer family vision plans, and each member usually gets their own exam and allowance. Still, check whether your kids already have vision care through your health plan. If they do, you might only need adult eye care coverage, which can lower your premium.
Vivna's licensed agents compare plans from 50+ carriers. Call Monday through Friday, 9am to 6pm.
Sources
- HealthCare.gov: Vision coverage (glossary)
- HealthCare.gov: What Marketplace health insurance plans cover
- American Optometric Association: Comprehensive eye exams
- National Eye Institute: Glaucoma Awareness Month
- CDC: Fast facts on vision loss
Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. Plan availability, networks and benefits vary by state and change over time.
Related guides
Find Local Health Insurance Help
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More local help: the Ohio health insurance guide, plus guides for Florida, Texas, Georgia and every state we serve.
Prefer to talk it through? Call 888-730-6031 Monday through Friday, 9 a.m. to 6 p.m. Eastern, for free help from a licensed agent.
