What does vision insurance cover?

There’s no uniform answer when it comes to whether vision insurance is worth it to a particular individual. If you wear glasses or contacts, you might find that having vision insurance reduces the total amount you spend to keep your prescription updated and filled.

In other words, the cost of the vision insurance premiums plus the out-of-pocket costs for covered exams and glasses or contact lenses might be lower than the cost of just paying out-of-pocket for the exams and eyewear. This will depend on how much the policy costs and the specific benefits it provides, as well as how frequently you replace your glasses or order new contact lenses.

Even if you don’t need corrective lenses, it’s important to keep in mind that the American Optometric Association recommends that adults under age 65 get an eye exam at least once every two years, and the recommended frequency increases to once a year after age 65.⁷ Of course you can choose to pay out-of-pocket for eye exams, but if having a vision insurance policy helps keep you on schedule with your eye exams, that might make it worthwhile even if you don’t need coverage for corrective lenses.

The cost of vision insurance will depend on the plan you select. It will also depend on whether the policy is sponsored by your employer (and if so, whether the employer pays any of the premium) or purchased on your own. And the premium will also depend on whether you’re buying a vision plan on its own, or a combined dental/vision plan.

If you’re buying your own stand-alone vision insurance, premiums in the range of $10 to $20 per month are common,¹ although there are plans with premiums as low as $5 per month.⁸

Vision plans will typically provide benefits for glasses or contact lenses, with the enrollee having the option of using the benefit allowance for either one.

The specifics will vary by plan, but your plan might have a copay for certain types of frames and lenses, as opposed to a set allowance that you can use toward the cost of contact lenses and the contact lens exam. Since the details are different for each plan, you’ll need to pay close attention to the plan you’re buying. Make sure you understand:

• What benefits the plan provides, including any benefit caps that are used.
• Whether the plan pays a set amount for certain services, or uses copays (meaning you pay a set amount and the plan pays the rest).
• Whether you need to use in-network providers for your eye exam and to obtain your glasses or contacts.
• Whether the plan offers more coverage for specific frame brands.

In most cases, contact lenses are elective, but they’re medically necessary for some people. Some vision plans cover medically necessary contact lenses,⁹ But VSP, the largest provider of vision insurance in the US,⁸ does not cover medically necessary contact lenses.¹⁰

In general, vision insurance will not cover LASIK, but vision insurance plans sometimes offer discounts on LASIK.¹¹ And some employers offer LASIK discounts for employees.¹² You can also use FSA or HSA funds, if you have them, to pay for LASIK with pre-tax money.¹³

In general, ophthalmologists treat diseases of the eye, such as macular degeneration or cataracts. That sort of care tends to be covered by medical insurance, but not by vision insurance.¹⁴

But not all care provided by ophthalmologists is covered by medical insurance. For example, LASIK is performed by ophthalmologists but is typically not covered by health insurance, since it’s generally not considered medically necessary.¹¹

Although insurance copays for an eye exam are often in the range of $10 to $40, the average cost of an eye exam without insurance ranges from about $50 to about $200 at one nationwide provider.¹⁵

But even without vision insurance, you can still get affordable eye exams that cost less than the full price. This can include visiting an optometry school where a supervised student will conduct your exam, or applying for an income-based program for low-cost eye exams.¹⁶

Obamacare is another word for the Affordable Care Act (ACA), but it’s often used to refer to the individual and family health plans available through the Marketplace/exchange in each state. These plans are required to cover certain essential health benefits, including vision care for children.¹⁷ Some Obamacare plans cover vision care for adults, but this is not required.

Learn more about the ACA and vision coverage

The federally run Marketplace (HealthCare.gov, used in 32 states) does not offer stand-alone vision plans.¹⁷ But some of the state-run Marketplaces do offer stand-alone vision plans that can be purchased by adults who want vision coverage. They include:

• Covered California¹⁸
• Connect for Health Colorado¹⁹
• DC Health Link²⁰
• Your Health Idaho²¹
• Kynect (Kentucky)²²
• Maryland Health Connection²³
• Nevada Health Link²⁴

In every state, Medicaid is required to cover routine vision care, including exams and eyeglasses, for children under age 21. This is part of Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

But for adults 21 and older, Medicaid coverage of routine vision care is optional,²⁵ so the coverage differs greatly from one state to another. If you’re enrolled in Medicaid, it’s important to understand the Medicaid vision benefits that are available in your state, keeping in mind that they might be quite different from the Medicaid vision benefits available elsewhere.

Original Medicare does not cover routine vision care, meaning eye exams, glasses, and contact lenses.²⁶

But like other types of health insurance, it does cover eye diseases, such as glaucoma,²⁷ diabetic retinopathy,²⁸ macular degeneration,²⁹ and cataracts.³⁰ And Original Medicare will cover corrective lenses after cataract surgery.³¹

Medicare Advantage plans can cover routine vision care, and almost all of them do so. In 2024, 99% of individual Medicare Advantage plans include at least some coverage for routine eye exams and/or corrective lenses.³² The specific benefits vary from one plan to another, so enrollees should make sure they understand the details, including the provider network, the applicable copays, and how much the plan will pay for glasses and contact lenses.