Health Insurance vs. Vision Plans

Insurance benefits and healthcare coverage can be very confusing. The language isn’t always clear, and sometimes you need to speak with a benefits specialist or human resources representative through your employer just to navigate what is covered and what isn’t. In general, there are a few things you should know about vision benefits vs. health insurance and how they may help cover your eye care needs.

There are many options for vision plans including EyeMed, Humana, VSP and more. They all have their own specific coverage benefits and amounts, but in general cover routine care such as annual exams and materials like glasses or contact lenses. They will pay all or part of the cost of your exam and eyewear and give you a timeline of how often you are allowed to get a covered exam or eyewear allowance. You are certainly allowed to order additional contact lenses or glasses, or to get exams more frequently, but the insurance provider will only cover a predetermined amount based on their annual or bi-annual timeline. Usually covered individuals pay a co-pay or a percentage of the cost of an exam and any associated eyewear.

The difference between a vision plan and health insurance is that health insurance generally covers only eye care in relation to a medical condition. For instance, if you need an eye exam because of cataracts, dry eyes, complications from diabetes, or in relation to diagnosed high blood pressure, then your health insurance will usually cover the eye care. You don’t need a vision plan for this coverage, but you may be able to use your health insurance to cover your medical eye condition or eye care needs and then use your vision plan to cover your glasses or contact lenses.

In addition to covering eye care for medical conditions, health insurance will typically cover care if you experience an eye injury or develop an eye disease.

The benefits of having optional vision insurance are that you can save a lot on eye care, and the plans are usually pretty inexpensive—typically just $12–$30 per month. Even if your employer doesn’t help cover part of your premium, many people like to buy the coverage to use for annual exams and new eyewear at a greatly reduced cost. Also, if you find that you’re not visiting your eye doctor regularly, paying for coverage is a nice way to make yourself accountable and schedule your visit to use your vision benefits.

Talk to your employer if you have questions about any employer-provided health care coverage or vision plans. Contact your optometrist to find out if your vision benefits are accepted, and how you can use benefits apply to your next eye exam or eyewear purchase.

Take Advantage of Savings and Flexibility

Navigating healthcare benefits and wellness perks can be tricky. Often the details are quite specific and involve websites or pamphlets than need to be studied to know what’s available to you. Flex Spending is one area that is often asked about, but under-utilized. It’s a great opportunity to save on necessary healthcare services and items.

Flexible Spending Accounts (FSAs) are popular features with many healthcare plans. An FSA works by deducting money from each paycheck, which then gets deposited automatically into a special flex account. This money is saved for you and you are able to use it to pay for healthcare expenses not covered by your medical plan. You pick what amount of money you want diverted into the account, and the advantage is that the funds you add to this account come out of your paycheck tax-free.

Your FSA can help pay for necessary eye care. Use flex spending money for prescription eyewear (glasses or sunglasses), contact lenses, or services such as routine eye exams, co-payments, deductibles, and more.

Employers often encourage employees to take advantage of these accounts because of the tax savings, and because it promotes thoughtful spending on health and wellness products and services to improve your quality of life. The downside? These accounts are on a “use it or lose it” basis and don’t usually roll over after a year. Don’t wait until the last minute to take advantage of flex spending!

So how do you take advantage of your FSA? First, read any literature you may have from your employer regarding the terms of flex spending, guidelines and suggestions for how to use it. Make sure you know how much you are putting into your account and consider price-checking to see what you will spend during the year so that you know how much to divert into the FSA each month. Once you know how to use your flex spending, make an appointment to see your eye care professional and get a yearly exam and eyewear. You may also want to discuss pricing with the provider so that you know what to expect for payment. Once you’ve had your exam and received your eyewear, keep your receipts and any necessary paperwork either to submit for coverage or to have for your records.

She careful to know the difference between FSAs and Health Savings Accounts (HSAs). An HSA is similar to an FSA in that you divert tax-free money from your paycheck into the account and use it on healthcare purchases, but these funds are not lost year-to-year. HSA funds accrue over time. They apply to the same sorts of purchases included prescription eyeglasses or sunglasses and contact lenses, so check to see what options are available to you.

Speak to an eye care professional today to learn more about how to use flex spending on necessary eye care.

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