What is vision coverage, and is it worth it?

Vision coverage helps pay for expenses related to eye care, such as eye exams, glasses and contact lenses. It can help people access proactive care to preserve eye health and even detect overall health issues.

Is vision coverage worth it?

There’s more to vision care than prescribing glasses or contact lenses. Even if someone has 20/20 vision, a routine eye exam can reveal the early stages of eye disease, such as glaucoma or diabetes. Prompt treatment can potentially lead to a better outcome.

Eye exams can also provide a time to discuss issues such as eye strain or fatigue caused by blue light emitted by electronic devices, such as phones and computer screens.

How does vision coverage work?

A vision plan helps cover vision care expenses in exchange for a monthly cost. Plans may be offered through an employer group plan or purchased as individual policies.

Many vision coverage companies cover the cost of an annual eye exam performed by an in-network provider. These policies may also help pay for glasses and contact lenses up to an annual maximum.

Is vision coverage the same as health coverage?

Vision and health plans cover different aspects of health. Much like a dental plan provides specialized coverage for oral health, a vision plan focuses on providing specialized eye care. Meanwhile, health plans offer broad coverage for the rest of the body.

Most health plans do not cover vision issues unless there is a medical reason to see a health care provider or in an emergency. Medical eye concerns include eye infections, floaters, eyelid styes, chronic dry eyes, glaucoma treatments and vision loss caused by a medical eye condition. Vision plans will defer to health plans for coverage in these medical situations.

What do vision plans cover?

Here are some common types of eye care coverage in comparison with health coverage. Plans vary, so check individual plan details.

*Some health plans, including some GuideStone^® health plans, may offer coverage for an annual vision exam. 

What does vision coverage not cover?

In addition to medical eye conditions, vision plans typically do not cover the following:

• Non-prescription glasses (e.g., reading glasses)
• Non-prescription contact lenses (e.g., colored contact lenses)
• Additional eye exams (beyond the number of covered exams)

How can someone get vision coverage?

Vision plans may be accessible through:

• An employer-sponsored vision plan: Some employers offer a vision plan and may pay a portion of the monthly cost to help reduce employee costs.
• A spouse’s or parent’s plan: Spouses or dependents under age 26 may be able to enroll in a spouse’s or parent’s plan through their employer.
• COBRA (Consolidated Omnibus Budget Reconciliation Act): Through this federal law, existing vision coverage may be continued for those who have experienced qualifying events, including termination of employment (for a reason other than “gross misconduct”) or a reduction in work hours.¹
• Private plans: Private companies may offer individual vision plans (not based on employment).
• GuideStone: Those eligible for GuideStone vision plans include paid employees working 20 or more hours per week at an eligible church, agency or institution affiliated with or that shares common religious bonds with the Southern Baptist Convention^®.
• If vision coverage is unattainable, some community health centers offer free or low-cost vision care. Universities with an optometry or ophthalmology program may also offer low-cost care. Other vision programs² may also be available.

Vision Plan Terminology Explained

Vision coverage may have fixed co-pays or cover a percentage of expenses. When researching policies, check for details to understand how the plan functions. Here are some common terms:

• Co-pays: This is a flat amount a plan member pays for covered vision care, such as frames or contact lenses.
• Deductible: This is the amount a plan member pays out-of-pocket before the plan’s co-insurance kicks in.
• Co-insurance: This is the amount a plan pays for eligible services after the deductible is met. For example, a plan may have 80%/20% co-insurance. This means that after the deductible is met, the plan will pay 80% and the plan member will pay 20% of future costs.
• Annual maximum: This is the most a vision plan will pay for the year. Once the maximum is met, the plan member is responsible for 100% of vision costs for the rest of the year.
• Waiting period: Some vision plans require members to wait a specified time before covering services. Keep in mind that preventive services may not be subject to this waiting period.

How to Minimize Vision Care Costs

Take advantage of routine eye exams that are already part of your vision coverage to detect issues early and resolve them quickly. If issues are left undetected or untreated, they may require more extensive and costly care later. For plans with networks, select in-network eye care providers for the lowest costs. If eligible, pay for qualified vision expenses with pre-tax money from a Health Savings Account (HSA).

Gain a Clearer Vision of Well-being

At GuideStone, we offer vision plans to promote your well-being, along with guidance on preventive care, tips for exercising on a budget, encouragement to rest and much more. For more information, contact us at Insurance@GuideStone.org or 1-844-INS-GUIDE (1-844-467-4843), Monday through Friday, from 7 a.m. to 6 p.m. CT.

GuideStone welcomes the opportunity to share this general information. However, this article is not intended to be relied upon as legal advice or medical advice, diagnosis or treatment.

¹DOL.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/an-employees-guide-to-health-benefits-under-cobra
²NEI.nih.gov/learn-about-eye-health/healthy-vision/get-free-or-low-cost-eye-care