What You Need to Know About Vision Insurance
It could help protect you from serious eye conditions
En español | Pete Hastert has diabetes and good reason to worry about his eyesight. “My grandma went blind from diabetes complications,” he says. Yet Hastert hadn't had an eye exam in over 30 years. The 71-year-old retiree from Tupelo, Mississippi, didn't have vision insurance, and with money tight, he avoided going to the eye doctor. Then he heard that EyeCare America offers comprehensive exams by volunteer ophthalmologists at no cost through its Seniors Program. Hastert got an appointment, and his eyes were healthy. “I finally have peace of mind,” he says.
An annual dilated-eye exam is important — it tests your ability to see, screens for age-related eye problems and even helps to detect chronic diseases, like diabetes. Nearly 2 percent of people 40 and older have glaucoma. For adults over 50, age-related macular degeneration (AMD) is the leading cause of severe vision loss.
Good vision insurance, though, isn't a given. “Expense is one of the key reasons why people do not get their eyes checked,” says Julian Roberts, executive director of the National Association of Vision Care Plans. But options do exist, even for those on the tightest of budgets.
The two types of coverage
Think about vision care as providing two services. One takes care of your day-to-day vision — it's mostly about glasses and contact lenses. The other treats eye disease and injury.
Your regular health insurance will cover the cost of diagnosis and treatment for any eye injury or disease that requires a doctor's help — no different from a broken bone or a heart condition — though with the usual copays and deductibles.
What medical insurance doesn't cover is the cost of eyeglasses, contacts or other costs related to everyday eyesight support. But there's a gray area. While a simple refractive exam (to figure out your glasses prescription) is not typically covered, if your ophthalmologist diagnoses you with a medical problem like glaucoma or cataracts, the entire visit may be billed under medical insurance, says Josh Ehr-lich, M.D., an assistant professor of ophthalmology and visual sciences at the University of Michigan in Ann Arbor. (Check with your doctor about individual office policies.)
That creates a bit of a hitch, since eye exams aren't covered unless you are diagnosed with a disease. But the best way to be diagnosed is to have an exam.
This pays for services like routine eyesight exams plus a large percentage of your costs for glasses and contacts. Upgrades such as anti-glare coating on glasses and transition lenses aren't necessarily going to be covered, so read the fine print to see if any part of the cost will be picked up.
Many people get a deal on vision insurance through their employers: You pay a couple of dollars per month as an add-on to your current health benefits and your employer pays the rest, explains Danielle Kunkle Roberts, cofounder of the insurance agency Boomer Benefits.
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Even if you're one of those lucky people whose sight is still sharp, it makes sense to take advantage of an employer-based vision plan, because there's a good chance you will need vision correction in the near future. “We conducted a study on adults ages 65-plus, and we found that 92 percent used eyeglasses for either distance or near-vision correction,” says Josh Ehrlich, the Michigan professor who coauthored the study, published in 2018 in the medical journal JAMA Ophthalmology. AARP Services chief medical officer Charlotte Yeh, M.D., recommends a yearly comprehensive, dilated-eye exam for every person over age 50.
Finding independent coverage
If you don't have access to employer-based vision insurance, you can buy a plan from a private insurer. But it requires some smart shopping.
Pay a monthly fee for access to discounted comprehensive eye exams and eyewear in a specified network of doctors and vision centers. “This is a great option if you are just looking to have some help on the cost of routine vision,” Kunkle Roberts says. Check the memberships you're already a part of: AARP Vision Discounts provided by EyeMed, AAA and retailers like Costco may offer cost savings.
Vision benefit packages
These plans act more like traditional insurance coverage. You pay a fixed dollar amount as well as a copay for the exam, glasses and lenses. Look for these packages through an insurance agent or broker, buy them online, or contact your state's department of insurance for information. You may also be able to add a vision-insurance rider to your dental insurance plan.
"All of the networks have significant options for consumers, from independent optometrists to retail locations like LensCrafters or For Eyes, to Costco, Sam's Club and Walmart,” Roberts says. But in the end, it may be better to save the money that you would have spent on insurance and put it toward the cost of glasses. Call a couple of vision care centers and ask these questions: If I paid cash, how much would a comprehensive eye exam be? What is the cost of contacts, glasses and add-ons like anti-glare coating? Is there a cash discount? You might be surprised at just how variable prices can be. Then compare that to what you might pay in a vision plan, and let that inform your decision.
What if you have no insurance?
Even if you're not insured through Medicare, your employer or marketplace insurance, you should still try to get a baseline eye exam.
EyeCare America's Glaucoma Program is one option for people who are uninsured and at an increased risk for glaucoma. They receive a free exam to detect glaucoma — an often symptom-free disease. Adults 65 and older are eligible to apply for EyeCare America's Seniors Program for a free medical eye exam, and those diagnosed with an eye disease will receive up to one year of follow-up care.
Be Your Own Eye Insurance
Sidestep eye disease and keep your vision secure with these simple dietary and lifestyle upgrades.
- Go dark. Green veggies like kale and spinach are rife with zeaxanthin and lutein — dubbed in a 2019 study “the most potent antioxidants” to prevent and reduce the risk of eye diseases, like age-related macular degeneration (AMD).
- Keep moving. Exercising for at least three hours per week was associated with up to a 41 percent lower risk of certain types of AMD, compared with maintaining a couch potato lifestyle, according to a 2017 study review.
- Wear shades. Whether sunny or cloudy, summer or winter, wearing sunglasses “is one of the simplest things you can do to prevent eye disease,” says Edward Manche, M.D., an ophthalmologist at Stanford University. UV exposure is associated with cataracts, AMD and eyelid skin cancer, among other conditions, research indicates.
- Order the tuna. Eating tuna regularly was found to reduce the risk of AMD by 42 percent, according to a meta-analysis in the journal Nutrients that looked at nearly 130,000 people. Fish, especially oily kinds like tuna, are packed with polyunsaturated fatty acids such as DHA and EPA, which lower inflammation and free-radical exposure.