Does Health Insurance Cover Eye Exams?

Millions of Americans are living with some form of eye problem. According to the American Academy of Ophthalmology, there are 24.4 million Americans over 40 that have cataracts. It’s also expected that around 50 percent of Americans will have cataracts by the time they reach 75 years old. And this isn’t the only alarming news coming from their report:

• Over 2.7 million Americans over 40 years old battle with effects of Glaucoma
• Almost 2.1 million Americans over 50 are living with age-related macular degeneration (AMD).
• Back in 2010, there were 9.1 million people in America with early stages of AMD and it’s expected that one in ten Americans will have late AMD by the time they’re 80 years old.
• Nearly 1.3 million Americans over 40 years old are legally blind
• Over 2.9 million Americans over 40 have low vision
• Close to 4.2 million people in America are visually impaired

Without the proper health insurance coverage, it’s difficult for Americans living with eye problems to obtain treatment. The problem is that not all health insurance policies offer coverage for vision care or preventive services like eye exams.

Vision Coverage Not Always Provided
If you qualify for health plans sold in the Health Insurance Marketplace, you will automatically receive pediatric vision coverage. However, these plans aren’t required to provide vision coverage for adults. So you may find certain policies that offer it and others that are less generous in their benefits. To ensure you receive the care and coverage you need, you’ll need to read through the coverage fine print or speak to an insurance agent from the insurer you’re considering.

If the plan you want to obtain does not have vision coverage, you can buy a stand-alone vision plan. You won’t find this in the Marketplace, so you’ll have to shop around elsewhere for a private plan. It’s also important to note that tax credits don’t apply to these plans. You can contact a local agent, broker or the state Department of Insurance to learn more about vision coverage plans.

What’s Included in a Stand-Alone Vision Care Plan
Vision insurance normally offer coverage for a portion of the cost for eye exams and prescription eyewear, including eyeglasses and contact lenses. Some even provide discounts for alternative options, like correction surgery like LASIK.

Vision care plans are different than typical health insurance policies, since they don’t offer unlimited benefits after co-pays or deductibles have been met. You can look at these as discount plans or wellness benefit plans that you have to pay an annual premium for.

It’s best to speak with your eye doctor’s office to determine what benefits will be available to you for the vision plan you have before you schedule an eye exam or purchase eyewear. The last thing you need is a surprise bill you can’t afford.

Where to Obtain Vision Insurance
You can enroll in a group vision insurance plan from your employer, school district, association or through government assistance programs like Medicaid and Medicare. However, if you’re not qualified for group plans or government assistance, then you can search for an individual policy. Some health insurance companies even allow you to tack on vision plans to your policy. HMOs, PPOs and indemnity health insurance policies normally allow this.