Understanding Your Vision Plan: What To Expect From Your Coverage

It’s no secret that vision discount plans and insurance can be convoluted and confusing. So, what can you do to understand your coverage better? In this blog, we’ll explain the basics of understanding Vision Discount Plans so that you can have a clearer picture of what benefits to expect.

Medical Insurace & Eye Exams
When it comes to medical insurance, eye exams are a bit of a “grey area.” So let’s take a look at some FAQs about insurance coverage.

• Will medical insurance cover my exam?
  • In most cases, medical insurance will not cover a routine eye exam unless a medical condition — diabetes, hypertension, glaucoma, etc. — is discovered during the exam. If you have a history of these conditions, then the exam will most likely fall under the net of your insurance. 
• Why is my refraction not covered?
  • Most medical plans, like standard Medicare, only cover health-related visits, not routine check-ups. Since a refraction is considered a routine procedure, it is often not covered.
• Will my medical insurance cover the cost of glasses?
  • No, medical insurance does not cover glasses. However, you may have a vision discount plan through your medical insurance company that does provide benefits towards glasses and contact lenses.

Vision Discount Plans
Vision discount plans or vision insurance are different from medical insurance in several ways.

• What is a vision discount plan?
  • A “vision discount plan” is often called “vision insurance,” but that term can be misleading. 
• What is the difference between vision discount plans and medical insurance?
  • There are a few differences between vision discount plans and insurance. The primary difference is that vision plans do not have a “deductible.” 
  • Medical insurance covers health problems, while vision plans provide benefits to standard check-ups and glasses.
• What is “covered?”
  • Generally, vision plans will “cover” or provide benefits towards eye exams, frames, lenses and/or contacts. In rare cases, the policy may cover both a full set of glasses and contact lenses, but most plans will only offer benefits towards one or the other.

Overview of Standard Coverage
To gain a better understanding of how most vision plans work, let’s take a look at some confusing terms. Customers often these terms misleading and feel more should be “covered” on their policy than is in reality.

• “Covered in full”
  • In most cases, vision plans will cover very little in full. The insurance provider may say, “Glasses are covered in full!” When, in actuality, that only applies to very specific scenarios for specific plans. 
  • Example: children under 18 often have the same plan as their parents. The child’s glasses may be covered in full, leaving you with only the vision plan’s copay of $10-$50. However, an adult’s pair of glasses on the same plan will likely not be covered in full, even with the exact products used on the child’s glasses. 
• There are cases where certain materials, prescriptions, and frames are covered in full. Here is a list of a few products that may fall into that category for your plan:
  • Frames under $130
  • Polycarbonate (lens material)
  • Single vision prescriptions
• Copays on basics
  • Most policies will not cover the basic materials needed for a complete pair of glasses in full. The three things required for glasses are a frame, the material a lens is made from, and the prescription type. Generally, at least one of these items will not be fully cover and incur a copay.
  • Additionally, most vision plans have a standard copay for materials that take effect even if the standard materials would be covered completely.

Upgrades & Additional Benefits
Often vision plans will offer additional discounts on Premium Lens Products. These options include anti-reflective lenses, blue light filters coatings, scratch resistance, digital surfacing, and luxury frames.

• Upgrades
  • Most prescriptions will require features like no-glare properties, thinner lenses, or special coatings to achieve the best vision for that patient. Thankfully, many vision plans help to make these properties more affordable by offering reduced pricing.
• Second Pairs
  • Many plans offer 20-30% off additional pairs of glasses, as well. This helps you find savings for those sunglasses you love, a pair of reading glasses, or an office lens to reduce eyestrain.
• Year-Round Savings
  • Your plan may offer additional savings on glasses throughout the year. 

Flex Spending
If you have a health savings card or flex spending, you can use it at your exam!

• A flex spending account can be used for many things including glasses, contacts, prescription sunglasses, and more

Vision Plans We Accept

• Avesis
• Christian Health Aid
• CompBenefits
• EyeMed
• Humana Vision Care
• Principal
• VSP/Eyefinity

Medicaid plans:

• Aetna Better Health of Kentucky
• Kentucky Medicaid
• WellCare

If you feel overwhelmed, trying to understand your vision discount plan, we can help. At Jarvis Vision Center, we will sit down and explain the ins and outs of your specific policy so that you can leave feeling confident in your savings. Our opticians are familiar with most major vision plans. We’re happy to work with you to maximize your benefits and get you into a pair of glasses or contacts that you’ll love.