The “Eyes” Have It: Ins and Outs of Vision Insurance

Author:Dan Heffley



It's been said that the "eyes are the window to the soul." Looking through those "windows" can actually tell us much about our overall health to the trained eye. During a visit to my optometrist, I learned that by looking at the inside of the eye, optometrists can tell if a person is at risk for high blood pressure and arteriosclerosis, as well as other health conditions. Through regular exams, (which go way beyond the eye charts of old) potential vision (and health) problems can be caught early and corrected. Children are particularly at risk. Most experts agree that children should be checked around the time that they can articulate answers, usually age three or four. Some suggest testing at six months old. Poor eyesight in children can cause them to fall behind their peers in school due to difficulty in reading. Amblyopia, or "lazy eye" may not have the characteristic physical misalignment of the affected eye. An eye exam can help diagnose it. If left untreated, it may not be treatable at a later date.

However, like all things medical, costs have been skyrocketing. Although costs are certainly defined by the region you live in, my recent trip to the optometrist would have cost me $125 for the exam and over $400 for a pair of reading glasses. My wife's more fashionable glasses would have run $600. We were saved by vision insurance. Quality plans can be had for less than $5 a month. Having vision insurance encourages having regular exams as well as saving money on glasses and contacts.

Most plans are broken down into the following coverage categories: Exams, Lenses, and Frames. Exams typically cost $10 through a PPO (Preferred or Participating provider) doctor. The insurance company will then allow a set of glasses with a co-pay on the lenses and a separate co-pay on the frames, up to a specific dollar amount. That dollar amount typically won't allow you to get the latest Gucci frames, but will get you into a decent pair of glasses. Remember, insurance is designed to help facilitate your health and well being, not your fashion sense. (Some would argue that their well being is inherently tied to their ability to look good.) Additionally, insurance companies will allow services in a specific time frame. The most common is one exam every 12 months, a pair of lenses every 12 months (if you get an exam every 12 months and your vision changes, you should be able to update your prescription), and a pair of frames every 24 months. So, you want to be comfortable in your frames because you'll be seen in them for two years before you can change.

What about contact lenses? Contact lenses typically will be covered on a plan, but instead of glasses-either you can get glasses OR contact lenses, not both. There also may be a "medically-necessary" stipulation...in other words, the insurance company will cover a pair of contacts that you need at a lower cost (because glasses would be too cumbersome for you) than if you just want contact lenses instead of glasses.

Along the same lines, many people want to have their vision surgically corrected through radial keratotomy (not used too much any more) or the more popular Lasik procedure. Like many of the discussions we've had before, insurance companies typically are in business to help people restore themselves to a healthy state. They want to do this in the most affordable way possible; otherwise they wouldn't stay in business. So, it's easy to see why insurance companies don't pay for Lasik procedures; your sight can be restored more quickly, and with less possible risk of complications with corrective lenses than with Lasik. Due to public interest, many vision insurance programs may have Lasik discounts. With the price of Lasik surgery dropping all the time, the value of these discounts are debatable.

Speaking of surgical procedures, what about other surgical procedures like cataract surgery or other medical problems/injuries to your eyes? Those types of expenses are typically covered under your medical insurance. Some medical policies also have an eye exam component built in.

The above programs constitute the bulk of what I see in my practice. There are other programs such as scheduled benefit programs that have a schedule or list of procedures and the cost to you for each. Some of these programs make sense, but by and large, the most satisfaction seems to come from my clients that have the program I've illustrated. The programs to avoid are the non-insurance discount plans. These programs almost never make sense as they are more of a marketing strategy by particular providers to increase business. For more on discount plans, see my April 16th column, Let the Buyer Beware.

Until next time, stay healthy!