Throughout our lives, unless we had some special issue with our eyes, we simply tried to remember to get an eye examination, then buy whatever glasses or contact lenses the eye doctor told us to get. That was about it. In some cases, our employers provided a vision plan along with our regular medical insurance.
If we were self-employed, we most likely just bit the bullet every so often and paid out of pocket for examinations, frames, lenses, and contacts, if we wore them. The bill for that cycle was high enough that it took a year or two to work through the sticker shock, just in time to do it again. After 50, getting eye examinations and monitoring our eye health is no longer a random thing, and vision insurance starts to play a vital role.
As our income-generating days wind down, and more and more of us find ourselves on fixed incomes, the cost of maintaining our eye health becomes a financial burden. It is typically a large outlay of money all at one time, which can be a budget buster. At this stage, we typically start looking at different types of insurances that help smooth out the patterns of our outlays. Vision insurance can do exactly that.
Vision insurance comes in two forms: either it is a ‘vision benefits plan’ that looks similar to other insurances, or it is a ‘vision discount plan’ that lowers the cost of eye care and eyewear by predetermined percentages. A review of what you have spent in the past on examinations, frames, lenses with all their enhancements, and contact lenses will be helpful as you decide which of the two forms of vision plan you prefer, and which company with that form.
Beyond the financial implications, vision insurance takes on added importance as we age because we become that much more vulnerable to declining eyesight and age-related eye diseases. Getting annual eye examinations becomes essential.
We start hearing from our friends about their cataracts and glaucoma. We hear phrases like ‘retinal detachment’ or ‘diabetic retinopathy.’ Occasionally we hear about someone who has ‘wet’ or ‘dry’ macular degeneration, a disease which is the leading cause of lost vision in those over 60.
Like anything else, the sooner we identify any deterioration of our eyesight, the better. While no one knows exactly what causes macular degeneration, for example, in addition to genetic factors there do appear to be some environmental factors at play. These we can affect with behavioral changes. We can slow down the progress of this disease which ultimately leaves us with no central eyesight, but with only peripheral vision.
With the Baby Boomer generation entering its 60s and 70s, authorities are expecting this disease to reach epidemic proportions. Medicare will cover special exams and treatment of issues like macular degeneration, but not the early exams that warn us that we might have the problem.
What is most at risk with worsening eyesight – and especially something that robs us of our sight – is our independence. We may have to ask someone to drive us places if it will be dark by the time we drive home. Maybe we have to relinquish our driver’s licenses altogether because we cannot pass the eye test.
In any case, we cannot afford to skip the examinations needed to monitor our eye health. The key is to find a way to afford the examinations themselves, which vision insurance can help us do.
Buying vision insurance raises many of the typical concerns of other types of insurance: the price (premiums, deductibles and copays), the length of commitment, how hard it is to cancel, whether there is a trial period and how easy it is to use the service.
Also, you want to know exactly what coverage you will have, any limits to the coverage, how soon you can use the coverage, if you can keep your existing eye doctor and how you would pay for services.
With a vision benefits plan, which includes eye exams and the purchase of eyewear, you will often have to make a co-payment (or copay), with the balance being paid by the vision plan, perhaps with certain limits. In the case of a vision discount plan, you pay for all services and eyewear out of pocket, but you will pay less than normal because of arrangements between the plan and the service providers.
In both types of plan, it is important to know what kinds of eye care practitioners are available in the plan: optometrists, ophthalmologists and maybe even refractive surgeons if LASIK and other corrective procedures are covered. You also want to know how extensive the eye examinations are and what they include. It is unlikely that they include specialized exams required by diabetes and other such diseases. Lastly, you want to know where you can go to select frames and lenses, and where you can purchase contact lenses if they are included in your plan.
Two areas differentiate what seniors prioritize from what others do: age-friendliness and health-related value.As for age-friendliness, most of the activity involved in the use of vision plans is identical whether covered by a benefits plan or a discount plan: You go for the eye examination, you take the results to an eyewear provider and you get your glasses or contact lenses.
The difference comes whether your preferred doctor is in the plan or if you are forced to find a new doctor. As we age, having to change doctors may be inconvenient, even unsettling. Also, if you go to an out-of-network doctor, you usually have to pay upfront and submit a claim for reimbursement, which means dealing with paperwork that with an in-network doctor is handled by the plan. Going out-of-network also increases the cost, as the plan will pay less than if the doctor is within the network.
Similarly, the health-related value of vision insurance is not affected by the type of plan you select. However, the more medications you take, even for common conditions such as high cholesterol and arthritis, the more you increase your risk for vision problems.
The importance of having your eyes examined increases as your health declines. Having extra health concerns to contend with – in addition to whatever conditions you already have – is an unneeded distraction. Eye issues can also increase your dependence on others, which may not be what you want. Lastly, as mobility decreases and going for an eye examination becomes difficult, if not impossible, the value of the service declines dramatically.
Some benefits plans require an annual commitment to a policy, although most offer the option of paying the premium in 12 monthly installments. In some cases, you can cancel your plan within a certain number of days after enrollment (often 30 days) but, to receive a full refund, you cannot have used any of the benefits. Others offer no refund at all.
Premiums vary from state to state, meaning you would have to go to each website and enter your zip code to get a quote for the different plans.
Deductibles do not seem to be common, although copays for different services are. Depending on the plan, you will likely have different allowances for frames, and defined costs for enhancements to the lenses (progressive, polycarbonate, anti-reflective, scratch-resistant, etc.).
What is most confusing is when plans offer different allowances and deductions depending on the type of facility where you purchase: independent optical location vs a national chain vs a regional chain.
In short, comparing apples-to-apples between plans is not an easy task, unless you know exactly what you want in advance, which is unlikely. Like many types of insurance, the devil is in the details, and most plans include a large amount of fine print.
Discount plans are somewhat easier to evaluate as there is often only an annual fee to pay, with no monthly premiums, and the discounts are clearly stated. However, discounts may also vary depending on the type of facility where you purchase, as well as from one state to another.
The initial evaluation criteria in buying vision insurance include the price (premiums, deductibles and copays), the length of commitment, how hard it is to cancel, whether there is a trial period, and ease of use.
Price: A vision discount plan usually involves just an annual fee, with no premiums. Vision benefits plans include premiums. In both cases, the greatest cost variable in the plan is in the calculation of copays, allowances for frames and lenses, and where you use the services.
Contract obligation: Most contracts tend to be annual. Some are inflexible in your ability to cancel, and others are willing to work with you, even providing a refund for non-used premiums. Others allow full refunds only if cancelled within a certain period, counted from enrollment, and stipulate that you cannot have used any benefits. It is important to read the company’s Terms of Service carefully to understand the commitment you are undertaking and how the company will handle your request to cancel.
Cancellation: Vision insurance plans, in general, do not seem to make it easy to cancel your plan. That is understandable: if you pay your premium one or two months, use the service for eye examinations, frames and lenses, then cancel, the company will have lost money because you will not have accumulated premium payments. You need to understand what you are committing to when you enroll.
Risk-free trial period: Vision insurance plans do not tend to offer trial periods per se. However, some give you the option of cancelling within a certain number of days from enrollment in order to get a full refund, but you cannot have used any benefits.
Ease of use: How easy it is to enroll in a vision insurance plan, as well as how easy it is to contact the company’s customer service if you need assistance, are important to your overall experience with a service. Some plans only provide live customer support during regular business hours, Monday through Friday. Be sure to check the company’s availability if having live access more often is important to you.
In selecting a vision insurance plan, you will want to know exactly what coverage you have. A basic plan includes a comprehensive eye examination, eyewear frames and lenses, and contact lenses if included in your plan. However, you will want to know how extensive the eye examination is, whether it includes dilation and how often you can have one. LASIK may or may not be part of the plan.
You will want to delve into what limits the plan might have, both in dollar amounts and in the permitted frequency of service and eyewear purchases.
Whether or not you can keep your favorite eye doctor is important to ascertain before signing up for a plan if that matters to you. If your doctor is not part of the plan, but the plan allows non-network doctors, it will most likely mean you will have to pay for services, then submit a claim for reimbursement, and the plan will cover less than if you used an in-network doctor.
Lastly, you want to know how payments will be made for any ongoing premiums. They are typically set up as automatic withdrawals from a credit card or your bank account. In that case, if you are not planning to renew at the end of a policy period, you would need to be certain the company knows in advance in writing, so they do not renew automatically and continue charging your card or account.