Understanding Vision Insurance

Submited by Cindy P on December 23, 2017

Earlier we talked about the differences between medical insurances, and now we will discuss vision insurance plans. They work differently than medical plans and are simpler in many ways.

Vision plans generally take the form of vision benefits plans or vision discount plans.

A vision benefits plan works how we typically think of an insurance coverage plan. The exam and materials are covered by insurance and the patient is responsible for a premium and a copay. Vision discount plans require an annual premium or membership fee in exchange for providing discounted exam and material charges. Patients can decide which plan works best for them.

While patients would use their medical insurance for appointments for reasons such as pressure checks, diabetic screenings, cataract exams, and injuries to the eye, vision insurance comes in handy when it’s time to check a patient’s vision prescription for glasses or contacts. This exam is called a refraction. Many plans also include material benefits, which would cover a portion of the frames, lenses, or contacts themselves.

Some vision insurance companies have contracted with medical insurance carriers and either provide vision as a covered benefit with particular medical plans or are available to purchase as add on packages through the medical insurance company. For example, Blue Cross and Blue Shield offer Blue View Vision, which is provided by the vision insurance carrier EyeMed. Many Medicare Part C Advantage Plans offer vision coverage.

Is vision insurance right for me?

 

 

 

Whether or not subscribing to a vision insurance plan is worth it depends on the individual. Medical insurance plans will cover the medical portion of a comprehensive exam for glasses, but they will not cover the refraction itself. They also don’t have any material benefits for a patient to use toward glasses or contacts. This includes Medicare- the only ways to avoid paying additional exam and materials charges with Medicare is to choose a Part C Advantage Plan that includes vision as a covered benefit. Patients can also subscribe to a vision coverage plan independently, instead of choosing a Part C plan. Patients who wear glasses may wish to research their options.

Vision plans are not subject to medical groups. Much like with PPO insurances, patients can schedule appointments with any doctor who accepts their vision insurance, no referral necessary. This works even if the the vision plan is partnered with an HMO medical insurance. For example, at LoBue Laser and Eye Medical Center we are contracted with the medical groups PrimeCare of Sun City and PrimeCare of Temecula. However, Regal Medical Group patients with VSP vision insurance may schedule appointments for glasses exams with us using their VSP insurance.

While some vision carriers are providing cards with member ID numbers for their subscribers, the majority do not.

The information needed for billing verification is usually the main subscriber’s name, social security number, and date of birth.  They will also require the patient’s social security number and date of birth. This information is used to check copay’s, verify the insurance will cover the exam, and allow the billing department to bill the insurance.

 

We hope these guides have clarified the world of insurances and how they work. If you would like to do some research on different insurance plans please click here for the top ten insurance companies that can break it down. With knowledge, everyone can choose the plans that work best for them.

Call our office today at (951) 696-1135 to schedule your complete vision exam for glasses.