Does Vision Insurance Cover Contacts?

Contact lenses are a convenient alternative to glasses that help you maintain adequate vision. However, switching from glasses to contact lenses can involve extra costs, especially if you don’t have the right vision coverage. So does vision insurance cover contacts, or will you have to pay out of pocket? Here’s everything you need to know. 

Understanding How Vision Insurance Works

Vision insurance is designed to help you cover the costs of routine eye care, including eye examinations, glasses and seeing your ophthalmology provider. Depending on your insurance plan, your vision policy may also cover LASIK surgery, contact lenses and other services. 

Typically, policies include a network of providers and varying degrees of coverage. The policy will generally cover some of your costs if you visit someone in your network. 

Most vision plans categorize contacts as either “elective” or “medically necessary.” Your policy might not cover the costs if you want contacts for convenience or cosmetic reasons. 

On the other hand, perhaps you have a vision problem that glasses can’t readily fix, such as severe astigmatism or aphakia (absence of the eye’s natural lens). In those cases, your vision policy will probably cover contacts.

So does vision insurance cover contacts? That depends on the nature of your condition and the terms of your policy. Make sure to read up on your plan and contact your plan manager for specific coverage details. 

If your plan covers contacts, it will also cover the costs associated with your eye exam and getting fit. Here’s where things can get a little confusing. 

Let’s say your plan doesn’t cover contacts, but eye exams are covered. Even in this instance, your policy might not cover the full cost of the contact lens exam because it could be viewed as a separate intervention. 

The cost of contacts with insurance varies based on several factors. These can include what condition your lenses are meant to correct, the quality of your coverage and whether you buy in bulk. 

On average, contacts for astigmatism range from $50 to $70 per box without insurance, which is about $600 to $840 per year. Your vision policy may cover some of these costs, reducing expenses out of your pocket. 

Suppose your lenses cost $50 per box and your insurance policy covers 50%. In this example, you’ll pay approximately $25 per month for your contacts, which equates to $300 annually. 

As your vision quality changes, you may have to get refitted for contacts. Fortunately, most vision insurance plans will cover an annual eye exam. If your plan covers the contact exam, you can get reevaluated yearly without any out-of-pocket expenses. 

Some insurance policies offer benefits for both glasses and contact lenses. However, you’ll encounter limits for each benefit period, which usually spans one calendar year. 

For example, your insurer could cover the costs of a new pair of glasses at the beginning of 2023. After that point, your policy probably wouldn’t pay much toward contacts until the next benefits period (2024). 

Some premium plans might let you get glasses and contacts in the same year. However, such policies are less common and more expensive. 

How to Check Your Coverage

Finding out whether your provider covers contacts is simple enough. To check, you can try any of the following:

• Review your insurance policy documents.
• Log into your insurance provider’s website.
• Contact your insurance provider’s customer service team.
• Visit your eye care provider and ask them to check your benefits.

Make sure you know your coverage details before booking an appointment so you can avoid any surprise costs. 

Tips for Maximizing Vision Insurance Benefits

After you find out what your plan does and doesn’t cover, identify in-network providers to maximize your benefits and minimize out-of-pocket expenses. Next, plan your exams and purchases according to your benefit period to maximize your coverage. 

You should also explore online retailers that offer discounts or rebates on contact lenses. You can combine these offers with your insurance benefits to reduce costs. 

Are you looking for a new vision plan to cover your contact lenses? Check out these options: 

If you don’t have vision insurance or your policy won’t cover contact lenses, here are a few alternatives to consider:

• Out-of-pocket payments: Paying out-of-pocket for your lenses can be a viable option if you have room in your budget. However, you could spend thousands per year on contacts for specialty lenses. 
• Discount programs and manufacturer rebates: Many manufacturers offer rebates and online discount programs. Explore these options to reduce your total costs. 
• Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs): An HSA or FSA helps you budget for medical and vision expenses by taking money directly out of your check and putting it in a separate account. You can use your FSA or HSA for eligible purchases, including contact lenses.

All of these strategies can help you obtain contacts without vision insurance. However, combining these tips with a great insurance plan is better. 

For instance, setting up an HSA or FSA through your employer will make budgeting for lenses, exams and related expenses easier. You can then use these funds to cover the difference between your policy benefits and the cost of contacts.  

Getting the Most Out of Your Vision Insurance Policy 

Does vision insurance cover contacts? As outlined above, the answer varies depending on the scope of your policy. Fortunately, it’s easier than ever to shop plans, compare coverages and find the right vision policy for your health and wellness needs. 

If you aren’t happy with your current coverage and want to switch to contact lenses, weigh your options. Getting an insurance policy can save you hundreds of out-of-pocket expenses and make it easier to afford the care you deserve. 

Frequently Asked Questions