Let’s face it, vision problems can be a real headache. Whether you’ve been squinting at the screen for hours or holding a book at arm’s length, glasses or contact lenses can make a world of difference. But when it comes to paying for them, many people wonder: Does insurance cover glasses?
If you’ve ever had to deal with the financial side of getting a new prescription, you know it can be expensive.
The last thing you want to do is shell out hundreds of dollars when you might be able to get some help from your insurance provider.
In this article, I’ll help you navigate the often confusing world of insurance coverage for glasses. I’ll break down what’s typically covered, what isn’t, and how you can make the most of your insurance benefits when it comes to purchasing glasses. Plus, I’ll share some tips and tricks to save you money along the way.
Does Insurance Cover Glasses?
Before diving into the details, let’s address the big question: Does insurance cover glasses?
The simple answer is: It depends. There are many factors at play when it comes to insurance coverage for glasses, including the type of insurance you have, the policy terms, and whether your plan specifically includes vision benefits.
Most health insurance plans, including employer-sponsored and individual plans, do not automatically cover glasses. However, many insurance plans do cover the cost of eye exams.
Vision insurance plans, on the other hand, are specifically designed to cover costs related to eye care, including prescription glasses.
But here’s the catch: Just because you have vision insurance doesn’t mean your plan will fully cover the cost of glasses.
Some plans offer partial coverage, while others provide discounts on glasses from certain providers or retailers.
In many cases, you’ll have to pay a portion of the cost out of pocket, such as co-pays, deductibles, or co-insurance.
Types of Insurance That Cover Glasses
There are three main types of insurance that may provide coverage for glasses:
- Vision Insurance
- Health Insurance with Vision Benefits
- Flexible Spending Accounts (FSAs) & Health Savings Accounts (HSAs)
1. Vision Insurance: The Best Option for Glasses Coverage
If you have vision insurance, you’re in luck. Vision plans are specifically designed to help with eye care costs, including eye exams, glasses, and contacts. The coverage varies depending on the provider and the plan, but typically, vision insurance will cover:
- Annual eye exams
- Discounts or allowances for glasses or contact lenses
- Coverage for frames, lenses, and lens upgrades
Some popular vision insurance plans include VSP (Vision Service Plan), EyeMed, and Cigna Vision.
These plans typically provide a fixed allowance (the amount they’ll pay) for frames and lenses. Depending on the plan, you may be able to get a free eye exam every year and discounts on new glasses every 1–2 years.
2. Health Insurance with Vision Benefits
Health insurance plans like those from major providers (Blue Cross Blue Shield, Aetna, etc.) often include vision benefits, but they tend to be limited. For example, health insurance may help cover the cost of eye exams if you have a medical condition like glaucoma or if you’re seeing an eye doctor for a specific health issue.
However, most health insurance plans do not provide full coverage for the purchase of glasses, especially if it’s just for a routine vision correction.
That said, some health insurance plans offer partial coverage or discounts on glasses when combined with a vision benefits rider.
If your health plan includes vision benefits, check the specifics in your policy to see if glasses are covered. Keep in mind that many health insurance policies won’t cover the cost of new glasses unless the prescription has changed significantly or you have a specific medical need.
3. Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs)
FSAs and HSAs are tax-advantaged accounts that allow you to set aside money for medical expenses, including vision-related costs like glasses and contact lenses.
These accounts can be a great way to save money on eyewear since the money you put in is pre-tax, meaning you won’t pay taxes on it.
The catch? You must use the funds by the end of the plan year or risk losing them (depending on the type of account you have). So, be sure to plan ahead and use your FSA or HSA funds before they expire.
Table: Comparison of Insurance Coverage for Glasses
| Insurance Type | Coverage for Glasses | Key Details |
| Vision Insurance | Partial or Full Coverage | Coverage includes eye exams, frames, and lenses, with allowances for glasses. Typically, coverage is available once every 1–2 years. |
| Health Insurance with Vision Benefits | Limited Coverage for Glasses | Only covers glasses in specific circumstances (e.g., medical need, prescription changes). Usually only covers eye exams for conditions like glaucoma or cataracts. |
| FSA or HSA | No Direct Coverage, but Funds Can Be Used for Glasses | You can use pre-tax funds from an FSA or HSA to pay for glasses. These accounts help reduce out-of-pocket costs but must be used within the plan year. |
How to Use Your Insurance to Pay for Glasses: Step-by-Step
Here’s a step-by-step guide on how to use your insurance benefits to buy glasses, whether you have vision insurance or health insurance with vision benefits.
Step 1: Check Your Coverage
The first thing you’ll want to do is check your insurance policy to see if glasses are covered. If you have vision insurance, find out what types of eyewear are covered and what your allowance is for frames and lenses.
You should also look for any exclusions or limitations, such as restrictions on the types of frames or lenses you can choose.
If you have health insurance, see if your plan includes vision benefits and whether glasses are included.
Many health insurance plans will only help with the cost of glasses if you have a medical condition that requires them, such as a change in your prescription or a specific eye disease.
Step 2: Visit an In-Network Provider
Many insurance plans, whether health or vision, have a network of preferred providers. By visiting an in-network provider, you’re more likely to get the full benefits of your plan, including discounts or coverage for glasses.
Check the provider list on your insurance company’s website or contact their customer service for help finding an in-network eye doctor or optician.
Step 3: Get an Eye Exam
Most insurance plans will cover or partially cover the cost of an eye exam. You may need to pay a copay or deductible depending on your plan. Once the exam is complete, your optometrist or ophthalmologist will provide you with a prescription for glasses.
Step 4: Choose Your Glasses
After your eye exam, it’s time to choose your glasses. If you have vision insurance, you may have an allowance for frames and lenses.
This means the insurance will pay up to a certain amount, and you’ll be responsible for the rest. Be sure to ask the provider if they accept your insurance and if any restrictions apply to the glasses you choose.
Step 5: Submit a Claim (If Necessary)
If your glasses are covered by insurance but not directly billed through the provider, you may need to submit a claim for reimbursement.
This is common with vision insurance, where you pay upfront for the glasses and then get reimbursed later. The insurance company will usually require you to provide an itemized receipt and a copy of your prescription.
Mistakes to Avoid When Using Insurance for Glasses
Here are some common mistakes to watch out for when using your insurance to pay for glasses:
1. Not Understanding Your Coverage Limits
Some people assume that their insurance will cover everything when it comes to glasses. In reality, many plans have limits on how much they’ll cover for frames, lenses, or eye exams. Be sure to read the fine print and understand what your plan covers before you start shopping for glasses.
2. Not Using an In-Network Provider
If you choose an out-of-network provider, you may not get the full benefit of your insurance coverage, and you could end up paying more out of pocket. Always check if the provider is in your insurance network.
3. Forgetting to Submit Claims
If your glasses are not paid for directly by the provider, you’ll need to submit a claim for reimbursement. Don’t forget to do this or you may miss out on getting your insurance benefits.
4. Overlooking Discounts
Some insurance plans offer additional discounts on eyewear. For example, you may be able to get a percentage off certain frames or lenses. Always ask about these discounts before you make a purchase.
Conclusion:
In summary, whether or not insurance covers glasses depends on the type of insurance you have and the specifics of your policy.
Vision insurance is the best option for full coverage of glasses, while health insurance may offer partial coverage or none at all. FSAs and HSAs can also be useful for paying for eyewear.
Be sure to check your coverage, visit in-network providers, and carefully read your insurance policy to avoid surprises.
And most importantly, don’t forget to take advantage of any discounts or allowances available to you. By doing your homework and following these steps, you can save money on glasses and make the most of your insurance benefits.
FAQs (Frequently Asked Questions)
- Does insurance cover glasses every year?
It depends on your insurance plan. Many vision insurance plans offer coverage for glasses once every 1–2 years. Some plans may cover eye exams annually, but glasses may only be covered every other year. Check with your provider for the specifics.
- How much will insurance pay for glasses?
Insurance coverage for glasses varies depending on your plan. Some vision insurance plans offer an allowance (typically between $100–$200) for frames, lenses, or both. You may need to pay any costs beyond that amount.
- Can I use insurance to buy any brand of glasses?
Some insurance plans have restrictions on the brands or retailers you can use. For example, you may have to choose from a specific list of frames, or your insurance may offer a discount at certain optical stores or online retailers. Be sure to check the details of your plan.
- What if I need glasses before my insurance plan renews?
If your insurance plan renews annually, you may have to wait until your new benefits are active before getting coverage for glasses. However, some plans may allow you to purchase glasses early and apply your benefits retroactively. It’s best to check with your insurance provider.
- Can I use both vision insurance and an HSA or FSA to pay for glasses?
Yes, you can often use your vision insurance to cover part of the cost of glasses and then pay the remaining balance with funds from an HSA or FSA. This allows you to maximize your savings. Be sure to check with your provider for details on how to combine these benefits.
- Is there any way to get discounts on glasses even if my insurance doesn’t cover them?
Many eyewear retailers offer discounts or promotions that can be used alongside insurance benefits. Some vision insurance plans also provide discounts for non-covered eyewear purchases. Look for deals at places like Warby Parker, LensCrafters, or other eyewear stores.
