Choosing an Eye Doctor Part Two Explaining Vision Insurance

When choosing an eye doctor to visit, it is worth considering what type of insurance coverage you have. In the eye care space there are two types of insurance to be concerned with.

Two Major Insurance Types

Major medical insurance, which is essentially your health insurance and another type of insurance called Vision Benefits. Vision Benefits sometimes are bundled and are a part of your major medical insurance or can be purchased outside your major medical insurance. Typically this type of Vision Insurance, also referred to as Well Vision insurance, is essentially geared toward a healthy individual and covers a portion of the well eye exam, and an allowance towards the purchase of glasses or contact lenses. If you have questions on what type of insurance coverage you have – we are happy to help decipher that for you. Often times well vision coverage bundled under a major medical insurance plan is hard to find. In fact, well over a third of the patients that have some form of well vision bundled under their major medical insurance don’t even know they have well benefits.

Explaining Well Vision Insurance

Typically this type of coverage is considered well vision insurance geared for those who are not dealing with ongoing care related to any type of eye disease. This type of benefit can be considered a pre-paid benefit, because your premium is based on the assumption you will use that benefit each year (or whatever the frequency of eligibility is). So, in a sense you or your company is paying for a benefit you will use. These benefits typically cover an eye exam every year or every two years, and provide a discount toward the purchase of frame and spectacle lenses or contact lenses every year or two years. Since the average cost of eyeglasses in the US is around $330, these pre-paid benefits are extremely helpful in lowering your cost. On average we have found that the savings these pre-paid benefits can help defray is on average about 38% to 42% off the usual and customary fee for a well eye exam and the cost of either glasses or contacts. Of course all plans are not the same so identifying your specific benefits if you have a pre-paid vision plan is highly recommended,

So if you’re generally healthy, and you do not suffer from any specific type of eye disease using your well vision insurance can help save you some money without sacrificing your care. Generally, Optometrists will accept these the types of plans and Ophthalmologists will not. Obviously you’ll want to ask specifically to find out if an Ophthalmologist accepts these types of plans before booking an appointment. And your eye care provider should ask you if you have any vision insurance when you call to make an appointment.

A typical well vision plan will identify if your are covered for an eye exam, the amount of co-pay you will be charged for that exam, what type of frame allowance you have, what type of lenses are covered and if contact lenses can be purchased in lieu of the eye glasses allowance. Your eye care provider should be able to help you identify the coverage before you arrive for your appointment. That process is part of we do for each patient that books an appointment with any of our doctors, whether that is an Optometrist or an Ophthalmologist, as it can be fairly confusing for patients to decipher on their own.

Using Major Medical Insurance

For those patients that are dealing with a particular eye disease – that type of coverage is usually handled by your major medical insurance, and depending on the plan, it is subject to deductibles, and co-pays.

The point is that it is important to consider what type of vision insurance you have; Well Vision,Major Medical or a combination. And make sure your eye care professional can help you decipher what type of coverage you have before you arrive for your eye care appointment.