Your Costs

Vision Coverage for Children and Adults

Summary

Most health plans cover medically necessary visits to an eye doctor. Sometimes they cover routine eye exams too, but to get complete vision coverage you may have to go to other sources. This article will tell you about those sources.

Private Insurance Options. The health insurance you get through your employer or the Health Insurance Marketplace might cover some eye care, but usually not eyeglasses for adults. The Affordable Care Act requires most plans to provide vision coverage for children. You can check with your health insurance carrier to see how much eye care they will cover. A stand-alone vision plan can cover eye exams, eyeglasses and contact lenses for the whole family.

Government Coverage. Medicare and Medicaid both cover medically necessary eye care, though Medicare doesn't usually cover routine eye exams or eyeglasses. Medicaid and the Children's Health Insurance Program (CHIP) both cover children's eye care, including eyeglasses. For adults aged 21 and over, each state decides whether Medicaid will pay for routine eye care or not. If you're a veteran, you could get Veterans Affairs (VA) help with your vision care, including discounts on eyeglasses and contact lenses.

Other Ways to Save on Eye Care. A flexible spending account (FSA) or health savings account (HSA) can help you save money on eye care. You can also try discount websites, retail stores, universities and colleges with optometry or ophthalmology programs, and community health centers to see if they offer low-cost eye care and/or eyewear.

Charitable and Public Sources of Free or Low-Cost Eye Care. There are several nonprofit organizations that provide free or low-cost eye care for people in need. These include New Eyes, VSP Eyes of Hope, All Children See, InfantSEE, EyeCare America and Prevent Blindness.

Vision Coverage for Children and Adults

Most health plans cover medically necessary visits to an eye doctor. Sometimes they cover routine eye exams too. But they don't usually cover eyeglasses or contact lenses for adults, though they may for children. To get more complete vision coverage, you may have to go to other sources. This article will tell you about those sources. It will also suggest other ways to save money on eye care and get free or low-cost eye care.

Private Insurance Options

Employer health insurance. The health insurance you get through your employer might cover eye care. Some plans only cover problems like a scratch on your cornea or an eye infection. Others will cover routine exams but only at certain times, like every two years. Health insurance plans don't usually cover eyeglasses or contact lenses for adults. But the Affordable Care Act (ACA) requires most plans to provide vision coverage for children. That includes free vision screenings for children. Check with your health insurance carrier to see how much eye care they will cover.

The Health Insurance Marketplace. Health insurance from the Marketplace follows the rules of the ACA. It will at least partly cover children's eye exams and eyeglasses. Some plans will cover adults too, but you need to check. See what's available in your state here.

Stand-alone vision plans. These plans can cover eye exams, eyeglasses and contact lenses for the whole family. Sometimes plans offer discounts on eye surgery like LASIK to improve your vision. There are two types of vision plans:

  1. A vision benefits package. This plan will pay for your eye care and eyewear for a yearly fee and a small copay.
  2. A discount vision plan. This plan offers a discount off eye care and eyewear for a yearly fee.

With either plan you may have to pay a deductible. A deductible is a fixed amount you pay to your eye doctor before you can get the coverage or discounts.

Government Coverage

Medicare. Medicare is health insurance for people over 65. It doesn't usually cover eye exams or eyeglasses. However, Medicare Part B will pay for an eye exam if you have an eye disease. One such eye disease is glaucoma. If you're at risk for glaucoma, Medicare Part B can pay for a glaucoma test every 12 months. Medicare Part B will also cover eye screenings for diabetic retinopathy if you have diabetes. If you need eye surgery for cataracts, Medicare Part B may cover one pair of eyeglasses or contact lenses afterwards. Check out our article to find out more about Medicare.

Medicaid. Medicaid is health insurance for people with low income. It will cover eye exams and treatment for children under age 21. For adults age 21 and over, each state decides whether Medicaid will pay for routine eye care or not. However, Medicaid will pay for medically necessary eye care. One example of this is an operation to repair an injury to your eye. Another example is treatment for an eye disease. Find out more and how to apply for Medicaid here.

Children's Health Insurance Program (CHIP). CHIP gives healthcare benefits to children up to age 19 who don't qualify for Medicaid but still need help. Different states have different benefits for CHIP. In all states, CHIP will cover some vision care. Your child's doctor will look for obvious eye problems at your regular well-child visits. If your child has Medicaid or CHIP, these visits are free. So is any follow-up eye care needed, including eyeglasses. Find out more here.

Department of Veterans Affairs (VA) benefits. If you're a veteran, the VA can help with your vision care. If you already get VA healthcare, you can get some or all of your eye care covered. This includes vision exams and screenings. If you have serious eye problems, you might be able to get more support and services from the VA. The VA can also help you get discounts on eyeglasses and contact lenses. If you have a condition that's related to your time in the service, you may be able to get eyewear for free. Find out more at VA vision care.

Other Ways to Save on Eye Care

Flexible spending account (FSA) or health savings account (HSA). If your employer offers it, an FSA or HSA can help you save. Both let you put money from your wages aside before getting taxed. You can then use this money to pay for eye care and eyewear for you and your family. You can also use the money to buy a vision plan. There are limits to how much you can put into an FSA or HSA each year. Ask your employer to learn more. And see our article on flexible spending plans.

Discount websites. There are lots of discount websites that offer cheaper eyewear that can save you money. Have a look online or ask a friend, family member or other trusted source for a recommendation.

Retail stores. Some bigger retail stores offer eye exams at much lower prices than independent eye doctors. Check out your local stores to find out more.

Universities and colleges. Check if your local universities and colleges have an optometry or ophthalmology program. If they do, they may offer low-cost eye care.

Community health centers. Your local community health center may offer free or low-cost eye care based on your ability to pay.

Ask for a discount. Don't be afraid to ask your eye doctor for a discount or payment plan.

Charitable and Public Sources of Free or Low-Cost Eye Care

You may qualify for help from charities or public programs. The organizations linked below provide free or low-cost eye care for people in need.

New Eyes is a nonprofit organization that provides free eyeglasses to those who have no resources.

VSP Eyes of Hope is a nonprofit that provides gift certificates for eye care and eyewear for adults and children with low income.

All Children See is a public service program that provides free eye care for children.

InfantSEE is a public health program that provides free eye exams for babies. Find a local doctor here.

EyeCare America is a public service program that offers free eye exams to adults over 65 who qualify.

Prevent Blindness is a nonprofit that has a list of organizations that help pay for vision care.

Your Action Plan: Get the Vision Coverage You Need

  • Ask your health insurance company whether they cover eye care and if so, how often and how much.
  • Think about whether it's worth getting a stand-alone vision plan.
  • Find out if you or your children are eligible for government help through Medicare, Medicaid or CHIP.
  • If you're a veteran, check out the VA vision benefits to see if you qualify.
  • Consider setting up an FSA or HSA through work to help you save on eye care and eyewear.
  • Check out discount websites that sell eyeglasses and contact lenses.
  • Look for discounted eye care at retail stores, universities or colleges and your local community health center.
  • See if you qualify for help from charities or public service programs that provide free or low-cost eye care.

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