A Guide to Vision Insurance for Seniors

Does Medicare Cover Vision?

Original Medicare does not cover routine eye care, including eye exams. Medicare also won’t cover glasses, frames, lenses, or contacts.

Medicare Part B, however, covers routine eye care for individuals diagnosed with certain conditions, including diabetes, macular degeneration, cataracts, and glaucoma. Coverage for these exams is up to 80 percent of the cost.

Barring these conditions, routine eye care will be expensive. The average eye exam costs around $170 to $200, with an average of $95 for a follow-up visit. The average pair of glasses costs $242 — and that’s only for the frames. Lenses cost an additional $110 or more. In 2021, LASIK surgery cost an average of $4,770 for both eyes.

Medicare Advantage

Medicare Advantage plans sometimes offer a vision care benefit, but the coverage you receive varies widely between providers and even plans. This form of insurance often hikes your monthly premiums without granting the full benefits of a stand-alone vision insurance plan.

How Vision Insurance Works

With vision insurance plans, you send your plan provider your monthly premium or set it up to deduct directly from your paycheck if your employer provides a plan. For these rates, you receive discounted services for select routine care.

Occasionally, plans will require you to see certain providers within their network, although not all come with that restriction. The more common restriction is that the care must be conducted by a licensed optometrist, college-certified in the services you receive.

What Vision Insurance Covers

Vision insurance coverage varies widely between plans, but most insurance policies cover routine eye care such as exams, glasses, and contacts. Most do not cover 100 percent of the cost, however, and usually require the plan holders to pay around 20 percent of treatment costs.

Basic plans cover preventive care, while comprehensive plans can cover extra treatment options such as progressive lenses and antireflective coating for glasses. Basic plans don’t usually cover elective correction procedures like LASIK eye surgery, but comprehensive plans often offer these treatments at a discounted rate.

Types of Vision Insurance Plans

There are two general kinds of vision care coverage: vision benefits plans and discount vision plans. The type you choose will change the coverage you are eligible for.

Vision Benefits Plans

A vision benefits plan is a traditional insurance policy that covers its stated services for the premiums you pay per month as well as copays at the treatment office when applicable. The average vision benefits plan can cost as little as $5 to $15 per month, but the price is mandated by the services offered.

This price is in addition to the copays and deductibles you will pay according to each plan.

Discount Vision Plans

Discount vision plans — sometimes called vision savings plans — are used like a club membership card at a store. By joining the plan, you become part of a group of members who get discounted fees for vision services, as long as you are treated within the plan’s network of providers.

This type of plan charges an annual fee, which is normally less expensive than a vision benefits plan. This, however, is in exchange for higher copays and deductibles than the other plan type.

How to Choose Vision Insurance

The best way to choose a vision insurance plan is to calculate how much you spend on vision care in a typical year, then compare that number to the cost of vision policies per month or year to get an idea of your potential savings with each type of plan.

In addition to insurance premiums, plans also have different copays and out-of-pocket maximums you should be aware of. If you’re currently on Medicare, consider switching to Medicare Advantage to use its vision care savings.

A stand-alone vision policy has its own advantages, however, such as more comprehensive benefits and unique coverage that differs among providers. With the value of vision insurance increasing as we age, consider both the network’s policies and the services you need when choosing among the many vision insurance plans available.