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What You Need to Know About Supplemental Vision Insurance

What You Need to Know About Supplemental Vision Insurance

VSP feature showing glasses

An estimated 93 million adults in the U.S. are at high risk of serious vision loss, according to the Centers for Disease Control (CDC), but only half have visited an eye doctor within the past year.

More than 11 million Americans have a current vision impairment that can be corrected, according to the National Eye Institute (NEI), but only 58% seek vision care. Common conditions include nearsightedness, farsightedness, astigmatism, and presbyopia.

The lack of preventive and corrective vision care in the U.S. is potentially due to a lack of vision coverage to help offset out-of-pocket costs.

Supplemental vision insurance such as a VSP® Individual Vision Plan can help ensure that you don’t become part of that statistic.

Taking Care of Adult Eyes

getting an eye exam

Having regular eye exams is essential in minimizing vision problems as we age. We only get one set of eyes and must care for them. The Alliance for Aging Research estimates that someone in the U.S. becomes blind or visually impaired every 7 minutes, in part, due to a lack of preventative vision care and treatment. 

A routine eye exam for adults often includes all of the following tests:

  • Eye muscle movement: Checks eye alignment and ability to target moving objects
  • Visual acuity: How well you can read letters on a chart at a distance.
  • Visual field: Checks your peripheral vision, or how much you can see without moving your head.
  • Retinal exam: After dilation, checks the back of your eye to view the optic nerve, retina, and retinal blood vessels
  • Retinoscopy: How well your eyes reflect light
  • Refraction: Flipping through different lenses to determine which provides you with clearer eyesight  (the “this or that” test)
  • Slit lamp (biomicroscope): Checking the front of your eyes for diseases and disorders.

Eye Care for Children

All health insurance plans that meet the “minimum essential coverage” requirement of the Affordable Care Act (also known as Obamacare) must include pediatric eye care. This is basic vision screening usually performed by the child’s pediatrician or family doctor. 

However, many parents add their children to their supplemental vision insurance to ensure they can access a comprehensive vision exam and routine vision care.

The American Optometric Association (AOA) recommends that infants receive their first comprehensive eye exam for screening purposes between 6-12 months and then again at 3, 5, and 6 years old. Once the child is in school, AOA recommends an exam every two years if there are no known vision problems or every year if vision issues have been detected.

Data from the AOA indicates that 61% of children with vision problems detected by school screenings do not receive help from a doctor afterward. And that’s with school vision screenings missing an estimated 75% of children’s vision problems, to begin with.

How Supplemental Vision Insurance Works

woman putting in contacts

Regular health insurance covers diagnosis and treatment costs for eye injuries or diseases requiring a physician’s care. This includes services provided by ophthalmologist doctors specializing in eye and vision care.

However, health insurance usually doesn’t cover the cost of eyeglasses, contacts, and related expenses. In many cases, it also doesn’t cover the optometrist’s services to assess vision defects and prescribe corrective lenses.

Vision insurance provides eye and vision benefits not covered under your health insurance (major medical) plan. It’s referred to as “supplemental” insurance because benefits are in addition to any that your health insurance plan may provide.

Vision insurance works similarly to health insurance. You pay a monthly premium in return for specified benefits. When you receive care from an approved provider, the plan pays for a portion of eligible vision care expenses such as exams, eyeglasses, and contact lenses. Most vision insurance pays a flat rate for some services and a percentage for others and covers a larger share of the cost when you use an in-network provider.

There are three types of vision care insurance plans:

  • Indemnity vision insurance lets you choose your provider. There is no provider network that you can choose from to help lessen your share of the total cost.
  • Health Maintenance Organization (HMO) vision insurance requires that you receive care from their provider network in order to receive benefits. These providers have agreed to charge discounted rates to HMO members, lowering your out-of-pocket cost. If you receive care outside of the network, benefits do not apply.
  • Preferred Provider Organization (PPO) vision insurance lets you choose from a provider network offering discounted rates. However, you can go outside the network if you are willing to pay a higher share of the cost.

According to VisionWatch’s U.S. Consumer Study, approximately 50.3% of Americans were enrolled in vision insurance coverage as of March 2020.

How to Get Supplemental Vision Insurance

The largest source of vision insurance is through an employer-sponsored group plan. This is sometimes bundled with dental insurance into a dental/vision plan. 

For those who don’t have access to an employer-sponsored plan or prefer a different schedule of benefits, you can buy a stand-alone vision policy directly from the insurance carrier or, if qualified, enroll in a Medicare Advantage plan that includes vision benefits.

According to the CDC, VSP Vision Care is the largest provider of vision insurance in the U.S., with more than 25% of the population enrolled in one of their managed care plans. The VSP national network includes 33,000 eye care professionals, of which 85% are optometrists and 15% are ophthalmologists. VSP offers Individual Vision Plans with customizable coverage options for those looking to buy a vison plan on their own.

Maximizing Your Vision Benefits

woman using an app

It’s important to know what products and services your vision plan covers. Supplemental insurance typically provides coverage for the following:

  • Routine eye exams for preventive care and prescription correction
  • Uncoated eyeglass lenses (single, bifocal, or trifocal)
  • Eyeglass frames, up to a specific allowance or dollar amount
  • Contact lenses instead of eyeglass lenses and frames, up to a specific allowance

Some plans, particularly stand-alone plans, offer higher allowances and may also provide benefits for corrective laser procedures such as LASIK and PRK. This is one of the reasons some people purchase a stand-alone supplemental vision plan instead of, or in addition to, the vision care plan offered by their employer.

In Conclusion

The number of Americans with blindness or visual impairment is expected to double by 2050 as the population ages. Protecting your eyesight requires regular vision care, including regular eye exams and corrective lenses where indicated. 

The lack of preventive and corrective vision care is primarily due to a lack of vision coverage to help offset out-of-pocket costs. Supplemental vision insurance can help ensure that you and your family receive the routine care needed to maintain your ability to see clearly and get the most out of life.

What you need to know about supplemental vision insurance

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