Vision Insurance in Texas

Vision insurance, also known as Vision Care Insurance in Texas, is an insurance policy that covers the cost of eye checks, exams, and other eye care costs. In Texas, vision insurance can come as a supplemental policy or a stand-alone policy. You can get vision coverage as a covered benefit under your major health coverage or as a stand-alone policy via the following channels:

• A private insurance company

• As part of a group plan

• From a government-sponsored health program, like Medicaid or Medicare Advantage

Understanding vision insurance, its benefits, and disadvantages is important when deciding if the plan is right for you.

What is Considered Vision Insurance?

Vision insurance is a type of insurance that covers the cost of routine eye exams, prescription eyewears such as contact lenses and eyeglasses, and other related services. Depending on the insurance provider, vision insurance provides reimbursement on frames for eyeglasses purchase as well as different contact lens options.

What is the Purpose of Vision Insurance?

The purpose of vision insurance is to save the insured from paying out-of-pocket for eye care. While vision insurance is not compulsory in the state of Texas, having a vision insurance can protect you in case of any required visit to the ophthalmologist or optometrist.

What is Vision Insurance for?

Vision insurance in Texas is for protecting you and your dependents from the financial strain that may be associated with paying for eye exams, eyeglasses, contact lenses, and other forms of eye care.

What are the Types of Vision Insurance

The types of vision insurance plans available in Texas include:

• Discount vision plan

• Vision benefits package

Usually, the vision benefits package gives policyholders free eye care services and eyeglasses or contact lenses within fixed amounts in exchange for a membership fee or yearly premium. The package also allows insurers to receive a relatively small co-pay (a fixed dollar amount) every time the insured uses the service.

On the other hand, a discount vision plan gives eyewear (eyeglasses or contact lenses) and eye care at reduced prices after the payment of a membership fee or yearly premium.

Do you Need Vision Insurance in Texas?

Yes, you need vision insurance if you or your dependents have been diagnosed with a pre-existing visual problem.

Policyholders need vision insurance because eye exams can be used to detect underlying medical problems. Even people with perfect vision are advised to conduct eye exams as much as they can. Also, Growing older should mean more vision exams. Individuals with bad vision, a family history of eye problems or medical conditions like diabetes that put people at risk of eye disease should purchase vision insurance to have more access to eye exams.

Why Do you Need Vision Insurance?

In Texas, vision insurance has a waiting period of at least 30 days. Texans without any form of vision insurance who suddenly develop vision problems will have to pay out-of-pocket.

Because prevention is better than cure, Texans with apparently perfect eyesight need vision insurance to avoid the unbudgeted expenses that may arise from wellness visits to the ophthalmologist. Typically, vision care is important because technology is advancing and people tend to spend long hours on their computers and phones. Over time, this can cause eye strain and refractive errors.

Also, Texas seniors (65 years or older) need vision insurance. According to a report published by the Center for Disease Control in 2020, about 12 million Americans aged 40 years and over are visually impaired and 1 million are blind.

If you have been diagnosed with some systemic conditions that can affect the eyes such as diabetes, you need vision insurance to get insurance coverage on your frequent visits to the ophthalmologist and/or optometrist.

How Much Vision Insurance Do you Need?

The amount of coverage you need for vision insurance in Texas depends on your eyesight and your ability to pay for the policy and be consistent with your premium. Vision insurance is usually purchased as a supplemental policy to your major health insurance plan, a separate policy, Medicaid (especially for Texans 18 and younger) and Medicare (Medicare Advantage, Medicare Part B).

Children in Texas are generally covered by Medicaid’s Children’s Health Insurance Program (CHIP).

When deciding the amount of vision insurance coverage you need, always speak to a Texas-licensed health insurance agent versed in vision insurance. They can guide you with deciding on which coverage is best for you.

What Vision Insurance Coverage Do you Need?

Most vision insurance coverages generally provide the following services and products:

• yearly eye exams,

• frames for eyewear,

• eyeglass lenses (including enhancement and lens coatings),

• contact lenses, and

• discounts for eye surgeries such as photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK).

Is Vision Insurance Required by Law in Texas?

No, vision insurance is not mandated by the Texas Insurance Law and the Affordable Care Act. Nobody acting within the law can penalize you for not having active vision insurance.

On a related note, insurance companies are required to provide vision care benefits for children in the ACA marketplace.

How Does Vision Insurance Work?

Vision Insurance in Texas works like other health insurance plans. When you purchase a vision insurance policy, you are required to pay a premium, usually on a monthly basis. If your vision insurance is part of an employer-sponsored group health insurance plan, the premium will be deducted from your salary.

In return, the insurance provider will provide discounts on vision care, eyeglasses, and contact lenses.

For a consultation and explanation of what vision insurance is good for and covers or does not cover in Texas, contact a professional agent who is licensed to operate in the state of Texas.

What Does Vision Insurance Cover?

Generally, vision insurance provides coverage for routine preventive eye care. These include eye examinations, prescription contact lenses, and eyeglasses. Additional comprehensive policies and plans provide coverage on specialty services such as coatings for eyeglass lenses and other enhancements like photochromic lenses, anti-reflective coating, and progressive lenses. These eye care policies might also provide discounts on corrective surgeries.

However, what will be covered by vision insurance depends on the insurance provider. For instance, ACA-compliant plans that provide basic eye care coverage for children (18 years and younger) are required as an Essential Health Benefit (EHB). This plan covers:

• Annual eye examination

• Eyeglasses including the frames and lenses OR contact lenses in place of the glasses

The Texas ACA marketplace is not mandated to provide vision coverage for adults. Adults can get vision insurance as part of their ACA health plan or as a stand-alone policy.

For Medicaid plans, vision insurance is covered under CHIP for eligible persons. Eligible persons include children 18 years and under who are citizens of the state, uninsured, and earn between 133% and 198% of the Federal Poverty Level.

Medicaid covers:

• Medically necessary eye examinations

• Ophthalmic ultrasound

• Corneal topography (examination for corneal abrasions, corneal irregularities, corneal disease, corneal injury, keratoconus, etc)

• Gonioscopy (for investigating the anterior chamber of the eye --between the cornea and iris.

• Regular and extended Ophthalmoscopy

• Sensorimotor examination

• Orthoptic and pleoptic training

• Non-prosthetic eyeglasses OR contact lenses

• Eyeglass frames

• Minor eyeglass repairs (repairs that cost $2 or less)

• Eyeglass loss or damage

• Intraocular lenses

What is Vision Insurance Good for?

Vision Insurance is good for paying for preventive care and treatments necessary to maintain optimal eyesight.

If you have questions about vision insurance, it is best to speak to a state-licensed health insurance agent.

What Does Vision Insurance Typically Include?

Vision plans typically give policyholders discounts on the following services:

• Eye examinations

• Frames for eyewear

• Lenses for eyewear (including enhancements and coating for lens)

• Contact lenses

• Vision correction surgeries like photo Refractive keratectomy (PRK) and Laser-assisted in situ keratomileusis (LASIK).

Who is Covered by Vision Insurance?

Vision insurance covers individuals that personally purchase the plan for themselves or it can be obtained via an employer. For additional coverage for spouses or children, individuals might be charged an additional cost for enrollment.

What Types of Items Does Vision Insurance Cover?

Basic vision insurance covers routine eye health costs like eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Some comprehensive plans provide coverage for specialty options like eyeglass lens coatings and enhancements, such as anti-reflective coating, photochromic lenses and progressive lenses. Some vision insurance plans in Texas provide discounts on LASIK and PRK procedures and other corrective surgeries.

However, eye injuries and diseases like glaucoma and cataract are not covered by vision insurance. Instead, they are covered by regular health plans.

Does Vision Insurance Cover Cataract Surgery?

Whether or not your vision insurance will cover cataract surgery depends on the policy type. While most vision insurance plans from private providers do not cover cataract surgery, Medicaid discounts the cost of cataract surgery.

Does Vision Insurance Cover Contacts?

Yes, most insurance providers offering vision insurance coverage cover the cost of contact lenses. However, the extent of coverage depends on the plan.

Does Vision Insurance Cover Eye Injury?

No. Treatments to eye injuries or diseases are usually covered by your regular health coverage, instead of your vision insurance policy. Regular health insurance plans cover emergency costs of an eye injury, unlike vision insurance that covers additional eye wellness benefits.

Does Vision Insurance Cover Glasses?

Yes. Vision insurance in Texas covers the cost of prescription eyeglasses.

Does Vision Insurance Cover Glaucoma Treatment?

No. Vision insurance available in Texas usually does not cover glaucoma treatment. Glaucoma treatment, like most eye diseases, is covered by most health insurance plans.

Does Vision Insurance Cover Lasik?

Most vision insurance plans in Texas do not cover Lasik surgery. However, there are some plans that provide discounts for their enrollees that need it. So, you should check your policy or speak to a licensed insurance agent in Texas about it.

What is not Covered by Vision Insurance?

Vision insurance will not cover the following:

• Extra eye examination beyond the one per year.

• Replacement of lost or damaged eyeglasses (except policyholder purchase warranty insurance).

• Application fees, missed appointment charges, or other miscellaneous expenses.

• Non-prescription eyewear (for example magnifying reading glasses).

• Any medical treatment for the eye. Surgeries, injuries, and other treatments should be catered for by the insured individual’s health insurance policy.

• Investigative or experimental treatments.

• Retinal imaging or fundus photography.

What Does Vision Insurance Typically Exclude?

Vision insurance almost always excludes eye treatment due to systemic causes such as diabetes. That is, an eye defect due to a different pathology originating elsewhere and not from the eye itself. An optometrist needs to refer an insured individual to an eye doctor (ophthalmologist) if such medical problems were discovered during a vision exam. LASIK services to treat eye injuries, diseases (glaucoma or cataracts), or infections are also excluded from vision insurance packages. Floaters, vision loss, dry eyes, and/or allergies are not included in vision insurance. Vision insurance does not cover medications prescribed by doctors.

What is an Example of Vision Insurance?

An example of vision insurance is the vision benefits plan. Generally, this plan provides annual eye examinations, lenses for eyewear, eyeglass frames, or contact lenses.

What is the Most Common Use of Vision Insurance?

Individuals with a history of eye-related medical problems commonly use vision insurance to get discounted treatment costs. Vision care insurance is relatively inexpensive, and it can save policyholders from extra expenses in the long term if they have recurring eye care problems. It is also used to reduce the cost of corrective eye surgeries.

What is the Difference Between Vision Insurance and Health Insurance?

The main difference between vision insurance and health insurance is that vision insurance gives coverage to routine eye care services, like periodic eye examinations and refractive services that allow doctors to determine the prescription. Vision insurance also offers discounts on contact lenses and eyeglasses. On the other hand, health insurance gives coverage to eye care services like diagnosis and treatment of eye illnesses like glaucoma or cataract. It also gives coverage for eye tests like visual field assessment and digital imaging.

Do I Need Vision Insurance if I Have Health Insurance?

A Vision insurance policy is still required even if an individual has an active health insurance policy. The difference between vision and health insurance is that health insurance gives coverage for eye care if the individual suffers from medical conditions like dry eyes, cataracts, diabetes complications, or high blood pressure. Vision insurance covers eye examination, glasses, or contact lenses which health insurance does not have provisions for. Vision insurance is beneficial because it saves money and it is relatively cheap when compared to health insurance. If an individual has an active health insurance policy, it is important to discuss with insurers the possibility of purchasing vision insurance.

Discuss your vision and health insurance needs with a Texas-licensed health insurance professional, who can advise you on the locally available options.

Who Can Get Vision Insurance?

Vision insurance is available to every individual irrespective of age, race, cultural background, or gender. There are two main groups of people that can get vision insurance: individuals who purchase vision insurance plans on their own or employees that are enrolled via the group plan of their employers. Vision care insurance can also be gotten via association unions or government initiatives like Medicaid or Medicare.

Who Qualifies for Vision Insurance?

Most adults qualify for vision insurance because according to the National Eye Institute, 66% of people above the age of 18 living in the United States use either eyeglasses or contact lenses.

Who Needs Vision Insurance?

Everybody needs vision insurance because eye exams can be integral towards the detection of hidden medical problems, even for individuals with no significant eye problem. Although older individuals should purchase a vision insurance plan for frequent vision exams. In the same vein, diabetic individuals, people with poor vision, or individuals whose family members have eye problems are advised to get vision insurance for more access to eye exams.

Who Should Get Vision Insurance?

Adults should have vision insurance if they can afford it personally or if their employer offers vision insurance.

You could speak to an insurance agent licensed in Texas to get more information on vision insurance.

PROs and CONs of Vision Insurance

PROs:

• Vision insurance can be added to other insurance plans.

• It can be purchased individually

• Premiums are relatively cheap.

• The plans reduce charges associated with corrective lenses.

CONs:

• It might be impossible to use out-of-network services.

• It might be a waste of resources if an individual does not need regular eye care.

• Some vision care insurance reduces the option of policyholders on certain services.

Why is Vision Insurance Good?

Vision insurance is good because it is not expensive when compared to other types of insurance policies. It may help an insured individual save money over time. It can also be beneficial towards the reduction of surgery cost if a policyholder ever needs eye surgery.

Why is Vision Insurance Bad?

Vision insurance might be bad because it might not provide the sort of service an individual requires during an emergency. It also does not give room for additional services outside of its network for treatment. In addition, it limits the options of policyholders because the plan might only support a certain line of brands.

Is Vision Insurance Worth it?

Generally, having access to vision services is worth it. It may be from your regular health plan or from a stand-alone vision insurance plan. Vision care insurance is worth it because of the coverage it provides on routine eye care like eye examinations, fittings, and corrective lenses. It plays an important role in keeping you healthy. Also, if you do not have vision coverage, you will have to pay the full cost of services that you recieve.

What Happens if you Don’t Have Vision Insurance?

Without vision insurance, an individual will have to make full payments for eye exams and any initial or replacement of eye wear (eyeglasses and contact lenses). Regular health insurance only caters to major eye injuries.

Why is Vision Insurance Important?

Vision insurance is important because it promotes good health. Eye exams are regarded as preventive care and vision plans cover the cost of an eye examination. Regular exams help with the identification of vision correction needs and the detection of dangerous eye diseases like cataracts or glaucoma. In addition, it saves costs by offering a discount on different eye care services like eye examination, prescription eyewear, and/or corrective eye surgeries.

What Happens When your Vision Insurance Lapses?

In case of a lapsed policy, the insurance company will stop offering a discount on services like eye examinations or purchase or replacement of eyewear (eyeglasses, frames, or contact lenses). If a vision insurance lapses, a renewal premium should be paid as soon as possible to allow policyholders to continue receiving services like routine eye examinations, contact lens fittings, contact lenses, and eyeglass lenses and frames. For further inquiries on insurance policy expiration, policyholders can speak to a licensed insurance agent in Texas.