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.
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:
- A vision benefits package. This plan will pay for your eye care and eyewear for a yearly fee and a small copay.
- 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.
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.
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.