Health insurance can be very confusing. It can be tricky to figure out what’s covered, particularly when it comes to eyewear.
If you use contact lenses, you may be wondering if they’re covered by insurance. Read on and learn the real deal when it comes to contact lenses and your insurance plan.
Are Contact Lenses Covered by Insurance?
The quick answer: it all depends on the kind of insurance that you have.
Insurance plans offer different types of coverage for contact lenses. You just have to know which type of insurance plan you have.
Or, if you’re still looking to sign up with an insurance provider, make sure to look for one that offers contact lens coverage. Let’s go through some of the plans that could cover contact lenses.
Types of Insurance Plans That May Cover Contact Lenses
Here are some of the more popular insurance plan types and how they support your recurring contact lens needs.
Vision Insurance
Vision insurance is a specialized type of insurance designed for your vision health. It covers practically everything that you need to make sure your eyes stay healthy. You get coverage for routine eye care, including eye exams, glasses, and contact lenses.
Unlike general health insurance, vision insurance plans are often separate policies or health insurance add-ons. This means that enrollment and payments are separate.
How to Enroll for Vision Insurance
In the U.S., vision insurance is available in a few different ways, including:
- As a standalone plan
- Through your employer
- Through a broker such as VSP, Aetna, and Eyemed
- Through government programs like Medicaid and CHIPS (Children’s Health Insurance Program)
What You Can Get
The way that vision insurance covers contact lenses varies by provider. Your plan can allot a specific dollar amount or percentage discount for contact lens purchases. Or, they can give you an annual allowance that can go to lenses or fitting fees. Other than that, your plan can also include fitting and other consultation fees.
Health Insurance
A small number of health insurance plans may include vision health and contact lenses in their coverage. This is not common, though, and is usually done under special circumstances, such as medically necessary contacts. Medically necessary contact lenses include lenses for conditions like keratoconus and severe dry eyes, or after-surgery lenses.
An example is Medicare and Medicaid, which may cover medically-necessary contact lenses but not routine contact lenses. You will need proper preauthorization and documentation from an accredited eye care professional to use this benefit.
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs)
While these aren’t insurance plans per se, FSAs and HSAs allow you to set aside pre-tax dollars to pay for qualified medical expenses, including contact lenses. FSAs are typically employer-sponsored health plans. HSAs, on the other hand, are included in High Deductible Health Plans (HDHP).
Contact lenses may be considered qualified expenses under these plans. (You need to check the specific vision care terms of your FSA or HSA to be sure.) If this qualifies, you can use these funds for eyeglasses and contact lenses purchases, as well as fitting fees and eye exams. Cosmetic eyewear is typically not included in the coverage.
What Can Affect Your Coverage
Remember that your coverage is dependent on a few factors. Always read the details of your coverage to ensure you get the vision care support that you need.
Corrective and Medical Necessity
If your contact lenses are prescription lenses that correct refractive errors or address a medical necessity, then it is likely that your insurance will cover their costs. However, cosmetic contact lenses are typically not covered since they aren’t a necessity. This typically includes colored contacts. Note that you’ll still need a prescription for cosmetic lenses, though.
Plan Details and Limits
Each insurance plan has its own rules, limits, and exclusions. Make sure to read your contract down to the fine print.
If you get vision health coverage, know exactly what’s covered. Are eye exams and fittings paid for by the insurance company? Are you given a dollar allowance for eyeglasses or contact lenses, or a percentage discount?
These details will typically factor into how you deal with your vision correction needs. For instance, if you only get a dollar allowance for corrective eyewear, maybe you’ll opt for a cheaper pair of eyeglasses instead of disposable contact lenses that will set you back at least $200 a year.
Annual Limits
Insurance plans will typically have limits to the amount that they pay for items covered, including contact lenses. You might even need to fund some of the cost.
Copays and Deductibles
Some plans require copays where insurance only kicks in after the deductibles have been met.
A copay refers to a set fee that you pay for services and purchases, like eye exams and eyewear. Deductible refers to your upfront share of the cost before your plan starts paying.
For example, let’s say you meet your $50 annual deductible by paying for three months’ worth of single-distance corrective contact lenses. Then, you begin experiencing problems seeing nearby objects. So you go to your eye doctor for an eye exam.
If it’s stipulated in your contract that you need to copay for vision care services, then you pay your share of the eye exam first, and then the rest is covered by insurance. The same goes if you have to buy eyeglasses for presbyopia.
Network Restrictions
Your insurance may require you to get your vision care services and products from within its network. This means you can only deal with specific eye doctors and eyewear vendors. Typically, insurance providers will include stipulations should you decide to use out-of-network providers.
You might need to pay upfront and file for partial reimbursement. Or, you might opt for balance billing. Balance billing is when the out-of-network provider bills you for the difference between their full charge and what you can reimburse with your insurance plan.
People opt for out-of-network providers because they may get faster service and more choices.
How to Make Sure You’re Covered
Review Your Insurance Policy
The first step to making sure your insurance will cover your contact lenses is to check the insurance policy documents. Better yet, call your insurance provider and ask these specific questions:
- Are contact lenses covered?
- If yes, what types of contact lenses are covered? Multifocal, toric? Cosmetic lenses?
- What happens if you buy your eyewear out of network? What specific documentation will you need to get a reimbursement?
Have Proper Prescription and Documentation
Make sure to get proper documentation and receipts for everything that you do for your eye health.
You’ll need a valid prescription from a licensed eye care professional to buy lenses. If lenses are medically necessary, make sure your doctor gives you the needed documentation for processing your insurance claims.
Use In-Network Providers
If possible, use in-network providers. This allows you to make the most of your insurance benefits and minimize your out-of-pocket costs.
This isn’t always ideal, of course. Just take the case of EZContacts, which offers you a lot more eyeglasses and contact lenses options at more affordable rates.
Out-of-network providers like EZContacts will typically do the coordination work for you and get in touch with your insurance provider. For EZContacts, you can simply fill out this insurance claim request form to get the process started.
Submit Claims Properly
Finally, make sure you understand and follow your insurer’s procedures. Make sure to have all your forms ready when you submit claims.
Having insurance is a good thing, but unfortunately, many find themselves lost in the process and documentation requirements.
What If You’re Not Covered
If insurance coverage for contact lenses is limited or not available, consider buying from reliable online vendors, such as EZContacts. Prices on these online stores are typically lower than market prices because these vendors have a direct relationship with the manufacturers.
You can also opt to join a rebate program. Brands like ACUVUE, Bausch + Lomb, and CooperVision offer clients who buy through their accredited vendors a rebate of up to $250. These programs typically require you to fill out a form and take photos of your receipt and purchases. You need to mail these to the specified regional locations to begin processing your rebate request.
Likewise, many online eyewear shops have rewards or points programs that you can use. You can use your accumulated rewards/points for future online purchases.
Or, consider getting eyeglasses instead of contact lenses. Vision insurance should cover corrective glasses. These are typically more affordable than contact lenses since a pair can last you for years.
TL;DR
- Contact lens insurance coverage depends on a few things: the type of insurance plan you have, the purpose of the lenses, and the specific terms of your coverage.
- Vision insurance plans commonly provide some level of coverage or allowance for contact lenses.
- Health insurance may cover lenses only if they are medically necessary.
- It is important to understand your policy, obtain proper documentation and prescription, and use in-network providers to make the most of your insurance plan.
- If you decide to use out-of-network providers, you might still get reimbursed for your eye care service or product. Refer to your insurance terms.
- Some out-of-network providers, like EZContacts, begin the reimbursement process for you.
- If contact lenses aren’t covered by your insurance, consider buying from discount vendors or joining manufacturer rebate and online eyewear vendor reward programs.
