Showing posts with label vision insurance costs. Show all posts
Showing posts with label vision insurance costs. Show all posts

Thursday, May 7, 2015

Is Vision Insurance Worth Paying For?

Today we are continuing to answer the question Is Vision Insurance Worth Paying For? We started addressing this topic with our past article, What Does Vision Insurance Pay For?

So, Is Vision Insurance worth paying for? The answer is: it depends! Whether a vision plan is worth it or not depends on what types of services and products you need. There are so many variations of eye care and eye wear that a person can use, and the cost is different for each of them. Let's go through a few examples to further explore the value of vision insurance.

First, the typical glasses patient. This patient has a mild prescription and no other eye health issues. They may need glasses either for reading or just for the distance, so they would need a single vision lens. They need three items at the optometry office: an exam, a frame, and a pair of lenses. An eye exam costs about $110, depending on where you have your exam performed. A median frame cost at a privately owned optical is around $180, and single vision lenses with a standard anti-glare coating(don't ever get glasses without an anti-glare coating!) costs about $160. The total cost for their visit would be $450.

With the VSP Base Plan that is available in North Carolina to individuals and families, the exam copay is $15. For that same pair of glasses as priced above, a VSP patient would pay $90. For the same bill, a VSP patient would pay $105. The annual premium for this plan totals to $234, so the VSP patient's total cost is $339. They saved $111 for the year. $111 is not a huge amount, but every penny counts, so I would say that the plan is worth it. Add to that the convenience of making monthly premium payments instead of having to come up with $450 all at once, and I would say a vision plan is definitely worth it to this patient. 

Second, we will review the established contact lens wearing patient. A patient that wears single vision, spherical(doesn't need toric contact lenses) contact lenses needs three items at the optometry office: an exam, a contact lens evaluation(evaluation, not fit, because this patient has worn contacts before, has been seen by the same optometrist in the past and was fitted for contact lenses), and an annual supply of contact lenses. Again, the exam will cost about $110, a contact lens evaluation for spherical lenses costs around $80, and an annual supply of monthly disposable contact lenses costs about $200 depending on the brand. The total bill is $390. 

Again, with the VSP Base Plan in NC, the exam copay is $15. The contact lens evaluation can be handled in one of two ways: one, the patient receives a 15% discount on the evaluation and pays $68 out of pocket, or, the patient receives a 15% discount on the evaluation and they use part of their contact lens allowance to pay for the evaluation. The outcome is the same, the patient will pay out $118 on their evaluation and annual supply of monthly disposable contact lenses. So their total for their trip to the eye doctor comes to $133. Their annual premium is $234, and their total out of pocket for the year is $367. They only saved $23. Almost a negligible savings amount, but again, there is the convenience of not having to come up with $390 all at once. Also, contact lens wearers should ALWAYS have a back up pair of glasses, so it stands to reason they will use their VSP policy to help with the cost of glasses at some point, and they will save more that benefit period. Was the vision plan worth it? Well you can look at it this way, $23 buys almost a tank of gas in my Ford Focus right now, so its nothing to sneeze at. 


Lastly, we will look at a patient that needs progressive lenses for their glasses. Patients that are struggling both in the distance and up close need progressive lenses because they are customized to multiple distances. There are many reasons progressives are superior to bifocals, but I won't get into that right now. Once again, the progressive wearer needs three things:an exam, a frame, and progressive lenses with an anti-glare coating. The exam is $110, the frame is $180, and the progressive lenses(using Essilor's Physio Enhanced design, with a standard anti-glare coating) will be around $420. Their total costs will be about $710. For those of you that haven't ever seen the price on progressive lenses- yeah, I know! 

With the VSP Base Plan in NC, the exam is $15 and the cost on the glasses will be approximately $231. This VSP patient's total cost for their trip to the eye doctor is $246. Their annual premium and  visit total to $480, which is a difference of $230 over the course of the year. VSP was definitely worth it to this patient!


There are many, many more variances on patient needs and how a vision plan will work for them. If you would like a specific example, please contact me, and I will be happy to evaluate your specific circumstance. Over all, for most people a vision plan is worth it simply because its stretches out the cost of eye care over the course of twelve months. Whether it will save you hundreds of dollars or not is dependent on your needs and wants. Is Vision Insurance worth it for you? Call me, and I will help you figure it out, or go to www.keepyoureyescovered.com .




Friday, April 24, 2015

What Does Vision Insurance Pay For?

Whether your employer is offering vision insurance, or if you are interested in vision insurance on an individual basis, you are probably wondering if you need Vision Insurance or not. To answer that, there are a few questions we need to address. The questions we want to ask today is, What Does Vision Insurance Pay For, or What Types of Services Fall under Vision Insurance?

First, lets discuss what Vision Insurance does pay for: Vision Insurance will cover a routine eye exam annually. A routine eye exam can be defined as an exam of a normal, healthy pair of eyes with no issues or abnormalities. A routine eye exam includes eyes with routine issues such as nearsightedness(myopia), farsightedness(hyperopia), people that are having issues seeing at intermediate distances(presbyopia) and astigmatism(which is when the cornea is not perfectly round).

Vision Insurance usually provides benefits for glasses, contacts lenses and also may help pay for the services required to fit a person for contacts, and evaluate their qualifications to wear contacts annually. The benefits for glasses are either a combined benefit with a maximum dollar amount, or there are separate benefits for frame and lenses. A Vision Plan may also discount lens treatments such as Transitions, anti-glare coatings, polarization(sunglass lenses that cut glare), or alternate lens materials to make lenses thinner and lighter. Vision Insurances rarely cover both contact lenses and glasses within the same benefit period; rather it is an "either, or" situation.

Now, Vision Insurance does not cover the following situations: medical eye exams, which includes, but is not limited to conditions such as diabetes, hypertension, glaucoma, macular degeneration and cataracts. If you are diagnosed with any of these diseases, vision insurance may not cover your annual eye exam. The cost will instead be applied to your medical insurance, because they are medical conditions that affect your eyes. Another more common reason to file an eye exam on your medical insurance is dry eye syndrome.

Any tests that are done to further examine your eyes due to the possibility of medical eye issues are not covered under Vision Insurance. Examples of these tests are fundus photos(photos of the inside of the eye), OCTs(Ocular Coherence Tomography, which scans the inside of the eye and produces very detailed read-outs), Visual Fields(testing your vision in different quadrants), and pachymetry(which measures corneal thickness).

Vision Insurance is also not meant for surgeries like Lasik, or surgery to remove cataracts. Cataract surgery will fall under medical insurance. Another important thing to know is that, if you go to an eye doctor for treatment for pink eye, a feeling like there is something in your eye, or any other eye injury, these services will also fall under your medical insurance.

In conclusion, Vision Insurance will cover an eye exam if you do not have any underlying medical conditions that affect your eyes. A Vision Plan will help cover the cost of glasses or contact lenses, whether you have healthy eyes or not. Even if you can't file your eye exam on your Vision Plan, you will still be able to file the cost of your eyewear, so do not write off the idea of purchasing Vision Insurance just because you are a diabetic. It can still save you hundreds of dollars on eyewear. In a future article, we will address how the cost of Vision Insurance compares to the cost of covered services.

If you have questions about vision insurance, please contact us at KeepYourEyesCovered.com