Vision Insurance in Texas
Vision insurance is a term used to describe insurance plans that cater to preventive vision services and prescription eyewear. If you have a health insurance policy, your plan may offer vision insurance as an extra benefit for an additional premium. Otherwise, you may want to consider a separate vision insurance policy to help with your vision needs.
Health Insurance vs. Vision Insurance
If you have a health insurance policy, some vision care will be included in that policy. Regular health insurance typically covers injuries to the eyes and eye diseases. On the other hand, vision insurance is for preventive care and prescription eyewear.
Vision insurance doesn’t include benefits for anything considered a medical service. This includes complete or partial vision loss, dye eyes, infections, floaters, eye disease, or complications from diabetes.
How Vision Insurance Works
Vision insurance works quite differently than your regular health insurance. However, it typically works the same way, whether you’re purchasing it as part of another plan or as a stand-alone policy.
Vision insurance is more of a discount and wellness type of policy. A plan will typically be based on a discount feature or a benefits package. In either case, they provide specific benefits or discounts in exchange for an annual or monthly premium. In addition, some plans include discounts for elective procedures like LASIK.
Vision Insurance Coverage and Benefits
You need to consult a plan’s policy summary to determine its specific coverage and benefits, but most vision insurance plans operate as either a benefits package or discount plan. Generally speaking, either type of plan will include benefits or discounts for annual eye exams, eyeglass frames, eyeglass lenses, contact lenses, and discounted rates for elective procedures like PRK and LASIK.
Benefits-Based Plans
A vision benefit insurance plan will provide free eye exams and eyewear services up to a specified dollar amount. Members will have a small copay for these services. Some plans may also include an annual deductible before benefits take effect.
Discount-Based Plans
A discount vision insurance plan in Austin, TX, will provide eye exams and eyewear at discounted fees.
Check your policy’s summary of benefits or discuss your plan with the administrative team at your eye doctor’s office to be sure of your out-of-pocket costs with either type of plan. This way, you’ll be sure to understand how much you’ll need to pay and avoid any unpleasant surprises.
Provider Networks for Vision Insurance in Austin, TX
Vision insurance plans may have networks associated with them – it all depends on the type of plan you choose.
A Health Maintenance Organization (HMO) plan will require that you see a provider within that network. You will not have benefits if you receive care from an out-of-network provider. HMO plans often have lower premiums because of this restriction.
A Preferred Provider Organization (PPO) also has a provider network, but the network is usually much larger. Plus, members will still have benefits outside of the network. However, the insured’s portion of expenses will be higher than if they had stayed within the PPO network.
The provider is not the only thing specific to a plan’s network. For example, you’ll also need to purchase eyewear from a store that is considered part of the HMO or PPO network.
Other plans only require that you be treated by either an optometrist or an ophthalmologist.
Vision Insurance Plan Limitations
As with other forms of insurance, vision insurance plans may include limitations. Let’s discuss the most common limitations contained in vision insurance plans.
Lens Limitations
A plan may only provide benefits for basic lenses, not lightweight or anti-glare ones.
Frames Limitations
There are nearly an unlimited amount of frames you can choose from when getting traditional eyeglasses. However, a plan may only offer a certain amount for frames. If you choose a more expensive frame, you’ll have to pay the difference. Some plans may pay the retail price for frames and require you to pay the wholesale price.
Traditional Glasses or Contacts
Many plans will only consider payment for either glasses or contacts in a benefit period – not both. So unless you want to pay for the additional option out-of-pocket, you would need to wait until the next benefit period to purchase the second piece of eyewear.
Waiting Periods
You’re probably familiar with waiting periods, which also apply to vision insurance. Depending on the plan, vision waiting periods might range from 30 days or three years. During that time, you may have access to reduced benefits, or you could have no benefits offered to you.
Frequency Limitations
Vision insurance plans typically have one or two-year benefit periods. Unfortunately, that means that you may only be eligible for exams or prescription eyewear once every two years.
Medicare and Vision Insurance in Texas
Medicare beneficiaries may have vision care included in their Medicare benefits. However, it depends on which products they are enrolled in: Original Medicare, Medicare supplements (or both), or a Medicare Advantage plan.
Original Medicare
Original Medicare includes Parts A and B. Some vision services are included in Part B benefits since they are performed on an outpatient basis. If an individual is experiencing severe vision problems or glaucoma is suspected, Part B will cover the eye exams needed to diagnose the issue.
Medicare Part B will also provide benefits for those with age-related macular degeneration. Individuals experiencing this will have coverage under Part B for diagnostic tests and treatment, including treatment with injectable drugs.
Lastly, Part B will also cover cataract surgery. This includes pre-surgery exams, anesthesia during surgery, and the surgery itself. It will also cover basic lens implants (monofocal only) and provide one pair of prescription glasses or contact lenses. Part B benefits include one year of follow-up care after surgery.
Remember that Part B will not cover these services at 100%. Once you’ve met your deductible, Part B works as an 80/20 split. Medicare pays 80%, and you are responsible for the remaining 20%.
Part B does not offer any preventive vision care.
Medicare Supplements
A Medicare supplement is one way you can get secondary coverage to help with costs that remain after Parts A and B have paid their share. For example, remember that 20% cost we talked about? A Medicare supplement will help pay that remaining expense.
There are ten Medicare supplements to choose from, so your coverage will depend on which of those plans you choose. The two most popular plans – Plan F and Plan G – will cover the entire expense. (Except the Part B deductible if you have Plan G.)
You can use your Medicare supplement anywhere that also accepts Medicare. Supplements do not belong to provider networks.
Like Original Medicare, Medigap plans do not offer preventive vision care coverage.
Medicare Advantage
Medicare Advantage plans are the other way Medicare beneficiaries can get additional coverage outside of Parts A and B. There is a lot to learn about Medicare Advantage plans, but let’s focus on their vision benefits.
You will have all the same benefits we described in Original Medicare. However, Medicare Advantage plans often offer extra benefits, which might include routine, preventive vision services. Each plan is different, but they may include routine eye exams, prescription glasses, and contact lenses.
Advantage plans often have provider networks. Therefore, you will need to receive your vision care inside the plan’s network to have coverage.
How to Choose a Vision Insurance Plan
Since vision plans are structured relatively simply, it is easier to choose a plan. If you already have a vision care provider you’d like to continue seeing, you should look for a plan they accept. If you consider an HMO or PPO insurance plan, make sure the provider participates in the plan’s network.
Otherwise, you’ll just need to compare the cost of a vision plan to its benefits. If you already have prescription eyewear or know that you’ll need them soon, a vision insurance plan could save you a lot of money. On the other hand, if you still have 20/20 vision, you might not see the value in a plan at this time. However, vision plans can be very affordable, so you also might enjoy the peace of mind they provide!
Alternative to Vision Insurance in Texas
If you aren’t sure that you need the coverage vision insurance plans provide, there are alternatives to vision insurance.
Individuals who have a Health Savings Account (HSA) can use their account to pay for routine eye exams, prescription glasses, and contact lenses. This is a great way to save money since you didn’t pay taxes on your contributions, and you can use the money to pay for medical services tax-free.
Others may benefit from a combination insurance plan like a Dental, Vision, Hearing (DHV) policy. As the name implies, these policies wrap benefits from all three categories into one plan.
Conclusion
Vision insurance can be very beneficial, especially for those who know they need routine eye exams and prescription eyewear. Our licensed insurance agents can help you compare the benefits offered from multiple plans to ensure you get the coverage you need. Call our office today and schedule your complimentary consultation.