Navigating health or vision insurance can quickly feel overwhelming, especially when it comes to understanding what it covers for eyewear. If you’ve ever wondered whether your insurance plan will help pay for contacts or eyeglasses you’re not alone.
Luckily, most insurance plans will cover new eyeglasses and contacts every 1-2 years. This means you can keep up with your prescription without having to pay out of pocket for new glasses and contacts.
What Does Health Insurance Cover?
When it comes to getting coverage for eyewear costs, the key lies in knowing the distinction between vision insurance and health insurance. These are separate types of policies, and each covers different eye-related services.
Coverage often includes:
- Regular eye exams
- Prescription eyeglasses (frames and lenses)
- Contact lenses
- Treatment for eye diseases like glaucoma, cataracts, or macular degeneration
- Emergency care for eye injuries
- Screenings for diabetic retinopathy
- Some vision surgeries
Most health insurance plans operate on a benefit schedule. For example, you might be eligible for a new pair of eyeglasses every year or every two years depending on your plan.
Does Insurance Cover Eyeglasses?
Most vision insurance plans include an annual or biennial benefit for eyeglasses. This may take the form of:
- A predetermined allowance (e.g., $150 toward frames)
- Fully or partially covered lenses with options like single-vision, bifocals, or progressives
Keep in mind that designer or premium frames typically cost more than the average allowance provided by your insurance, so be prepared to pay out of pocket if you opt for a high-end style.
Lens Enhancements and Add-Ons
Features like anti-glare coatings, blue-light protection or transition lenses may not be fully covered by every insurance plan. However, many offer partial coverage on these add-ons, so it’s worth asking about your options.
Does Insurance Cover Contact Lenses?
Vision insurance typically offers coverage for contacts in one of two ways:
- Allowance – A set dollar amount (e.g., $150 annually) to put toward contacts.
- Discounted Rates – A percentage discount to reduce the cost of contact lenses.
Which Contacts Are Covered?
Most plans cover soft disposable contacts, though specialty lenses—like gas-permeable lenses, toric lenses for astigmatism, or multifocal contacts—may require you to pay more out-of-pocket.
Annual Contact Lens Exams
Fitting appointments for contact lenses are often not included in your general eye exam coverage. Be sure to check whether your insurance provides a benefit or discount for these fitting exams.
Maximizing Your Vision Insurance Benefits
Understanding and strategically using your insurance benefits can make a big difference when it comes to saving money on eyewear. Here’s how to make the most of your plan:
1. Use Your Allowance Wisely
If your plan provides an annual allowance for eyewear, be conscious of how you spend it. For example:
- Combine your allowance for a higher-quality pair of glasses.
- Alternate between getting glasses one year and contacts the next.
2. Pay Attention to Timelines
Some vision plans refresh benefits on a calendar year, while others operate on a rolling basis. Make sure to use your benefits before they expire to avoid missing out.
3. Check for Discounts Beyond Coverage
Even if your insurance allowance doesn’t cover all costs, many vision plans include discounts on additional purchases, such as backup glasses, specialty lenses, or extra contact lens boxes.
What if You Don’t Have Vision Insurance?
If vision benefits aren’t included in your health insurance you may still be able to get some coverage. For example:
- Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA): These accounts allow you to set aside pre-tax dollars for medical expenses, including glasses and contacts.
- Employer perks: Some employers offer discounted vision benefits as part of healthcare packages, so double-check if you have access to these perks.
How to Choose the Right Health Insurance
When it comes to choosing the best plan for your needs, consider these key factors:
- Frequency of replacement: Do you want to update your frames or contacts every year? Choose a plan with frequent allowances.
- Lens needs: If you often opt for lens add-ons like anti-glare or progressive lenses, look for a plan that offers robust coverage for enhancements.
- Budget vs. benefits: Compare the monthly premium cost against the allowance or discount you’ll receive to determine overall value.
Find the Right Eye Care Professional for You
The question of whether insurance covers contacts or eyeglasses ultimately depends on the type of health insurance plan you have. The key to making the most of these benefits lies in understanding what your plan includes, asking the right questions, and exploring your options.
MEye Health, will work with you to help you make the most of your vision benefits to help you maintain your best eye health. Take advantage of your benefits and book an appointment with us today!
