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Health Insurance, Vision Insurance or Both?

by | Dec 11, 2024

Are Your Eyes Covered?

Vision insurance is a good way to reduce eye care expenses, especially if you are among the millions of Americans with some degree of vision impairment. According to the CDC, the cost of eye care prevents about half of Americans from seeing an eye doctor. In most cases, lack of adequate health insurance kept individuals from seeking care.

If you have health insurance, your policy may cover some vision services. However, it is important not to make assumptions about what is covered. Contacting a health insurance agent who will help you review your policy can prevent surprise bills if you need services later.

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Health Insurance, Vision Insurance or Both?Pin

What Does My Health Insurance Policy Cover?

Your health insurance policy covers services that address medical conditions, including eye-related issues. For example, health insurance covers vision surgery for fixing a detached retinal or removing cataracts, but it does not cover routine eye exams and items such as glasses or contacts.

 

What Does Vision Insurance Cover?

Vision insurance pays for a portion of expenses such as basic preventative care, including vision tests and eye exams. It also covers eyeglasses, including the lenses and the frames, and/or contacts. Depending on your plan, there may be additional benefits, such as coverage for daily disposable contacts.

Vision insurance does not cover eye surgeries. If your optometrist notices a medical problem during your annual eye exam, they will refer you to a medical doctor, such as an ophthalmologist, for further evaluation. From there, your health insurance would pay for treatment if it were deemed “medically necessary”.

 

Does Insurance Cover Corrective Surgery?

Corrective surgery has become an increasingly popular choice for those with less-than-perfect vision. Despite its convenience and cost-saving benefits, corrective surgery is not medically necessary and is not covered by either your health or vision insurance. However, because it can ultimately save the insurance company money, many vision plans include discounts that may help you afford surgery.​

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Do I Need Both Health and Vision Insurance?

If you wear glasses or contacts, the benefits of vision insurance are obvious – annual eye exams can be pricy, and depending on your prescription and eye health, corrective lenses can be a significant expense.

However, even if you have perfect vision, you should not skip eye exams. These exams can detect hidden medical problems, including brain tumors, certain types of cancer, high cholesterol, high blood pressure, thyroid disease or vitamin deficiencies. If you are under 40, current recommendations are that you visit an optometrist every five to ten years. As you get older, more frequent appointments are recommended.

If occasional routine appointments are all you need, then you probably do not need vision insurance. However, if you have poor vision or a family history of eye disease or a condition like diabetes that increases your risk of eye disease, vision insurance can save you money.

 

Getting Vision Coverage with Nevada Insurance Enrollment

Vision insurance is generally affordable, but benefits and out-of-pocket costs vary widely. At Nevada Insurance Enrollment, our health insurance agents help you find the right plan for your needs.​

You Can Still Buy Health Insurance From a Local AgentPin

You Can Still Buy Health Insurance From a Local Agent

The way health insurance is being marketed may give you the wrong impression that Nevada Health Link is the ONLY place to buy health insurance these days, but that is NOT the case. You can continue to buy your health insurance from the same agents and agencies you’ve always bought your health insurance from.

Is Health Insurance Worth The Cost?Pin

Is Health Insurance Worth The Cost?

If you experience a more extensive medical emergency and require hospitalization, hospital bills may quickly become a burden. A three-day stay, for example, could set you back about $60,000 depending on what tests are ordered and what happens during your stay.

What is Co-Insurance?Pin

What is Co-Insurance?

Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.

 

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Things Potentially NOT Covered By Your Health Insurance

To be fair, in recent years, health insurance companies have made strides towards transparency. If you have an ACA-compliant plan, there are many services that your health insurance is legally required to cover, taking some of the guesswork out of budgeting for health expenses.

Medical Loss Ratio

This Medical Loss Ratio states that when a family or individual buys a medical plan, 80% of every dollar collected and paid to an insurance company MUST pay medical claims/research. So that leaves the insurance company to pay ALL of their expenses with the remaining 20%. .20 cents on the dollar for their employees, buildings, broker costs, etc.

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