If you wear contact lenses, you may wonder whether your insurance plan offers full or partial coverage.
Contacts are typically covered by insurance. But how they're covered depends on your plan and your situation.
They could be covered by either a vision or health plan. Vision insurance typically covers routine eye care and contact lenses, while medical insurance may cover care for eye diseases and injuries.
Generally, contact lenses are covered under your vision insurance plan, rather than your health plan.
Specific coverage amounts depend on your plan details, but a typical plan includes a discount on your contact lenses, or in the case of medical necessity, full or partial coverage.
Your vision insurance also likely covers at least part of your contact lens exam, which is different from your regular vision exam and is required to get a contact lens prescription. It typically includes a test of your vision sharpness, specific measurements and fittings, and a tear film evaluation to determine the best lenses.
Your doctor will also guide you on lens care, insertion, removal, and answer any questions.
Your health insurance may cover treatment for eye injuries and eye diseases, which can include contact lenses. Health insurance might step in if you have medical needs due to certain eye conditions such as:
- Keratoconus: A condition where the cornea thins and bulges into a cone shape, distorting vision.
- High ametropia: Severe nearsightedness or farsightedness that requires strong vision correction.
- Anisometropia: A significant difference in prescription between the two eyes, causing imbalance.
- Aphakia: The absence of the eye's natural lens, often after cataract surgery.
- Dry eye disease: A condition where the eyes don't produce enough tears, leading to discomfort and blurry vision.
- Irregular astigmatism: Uneven curvature of the cornea or lens, causing distorted vision that glasses may not fully correct.
In some cases, your insurance will not cover the cost of your contact lenses. This could include:
- Elective contacts: If you choose contacts for convenience rather than medical necessity, vision insurance may offer only partial coverage, typically providing an allowance or discount instead of full coverage.
- Replacement lenses: Contact lens plans typically cover one set of contacts per coverage period. So, if you need a new pair before the period ends, they may not be eligible for plan discounts.
- Specialty or cosmetic contact lenses: Vision insurance generally doesn't offer full coverage for specialty contact lenses such as hybrid lenses, color lenses. or multi-focal lenses.
Contact lenses can cost anywhere from $50 to $1,000 per year, depending on how often your contacts are designed to be changed (daily, monthly, or yearly).
Pricing also varies based on the type of contact lens, such as:
- Monthly lenses: Also called soft contact lenses, these are replaced once a month, are typically the most affordable.
- Extended wear contact lenses: These are safe to wear overnight and are slightly more expensive than the monthly option.
- Rigid gas permeable contacts: Lenses that are designed to be replaced annually, are more durable, and tend to be the most expensive.
Here are some steps you can take to optimize your contact lens insurance coverage:
- Review your insurance plan to make sure you understand exactly what contact lens benefits are covered.
- Use in-network providers, as your plan will cover more of their costs, as compared to out-of-network providers.
- Look into a vision plan in addition to your traditional health insurance plan for coverage beyond what your current plan provides.
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